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Jul 2019

Managing Benzodiazepine Use in Older Adults

Introduction

Older adults (age 65+) have the highest rate of prescription sedative use among all Canadians at 15.6%. This is a concern because, as patients age, their bodies respond to medications differently and some medicines become less safe than others. Using benzodiazepines in older age increases patients’ risks of cognitive impairment, delirium, falls, fractures and motor vehicle accidents.

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Information

About the Tool

Re-evaluating the risks and benefits of all medications as a patient approaches the age of 65 is a routine part of medicine. It is particularly important to review the use of benzodiazepines, given the patient safety risks associated with the use of this medication for mental health or insomnia in advanced age. This tool is designed to help primary care providers assess and discuss with patients aged 65 or older, the potential risks and benefits of benzodiazepines. It also contains steps to support primary care providers in safely discontinuing, starting or continuing to prescribe benzodiazepines for their older patients.

The tool is divided into four sections to support providers in determining whether a benzodiazepine is appropriate or problematic, and providing care accordingly:

  1. Potential risks and benefits of benzodiazepines
  2. Discontinuing benzodiazepines
  3. Starting and continuing benzodiazepines 
  4. Alternatives to benzodiazepines 

Throughout the tool, providers will also find helpful talking points, practical tips for how and when to bring up benzodiazepines with patients and links to relevant patient resources, services and supports.

Patient Postcard: You May be at Increased Risk

To encourage patients to bring up their use of benzodiazepines during their next appointment, a patient postcard was developed to accompany the Management of Benzodiazepine Use in Older Adults Tool. This postcard can be printed and either mailed out or handed out to rostered patients aged 65 or over. Disseminating patient material aimed at encouraging older adults to take an active role in ensuring their medications are safe has demonstrated measurable increases in patient-led discussions with providers about their medications, and has led to discontinued benzodiazepine use among chronic consumers of inappropriate benzodiazepines.

The Management of Benzodiazepines in Older Adults Tool was developed using the Centre for Effective Practice’s integrated knowledge translation approach. This approach ensures that providers are engaged throughout the development processes through the application of user-centered design methodology. Clinical leadership of the tool was provided by Dr. Felicia Presenza. Target end-users and clinical experts were also engaged to provide feedback.

The Management of Benzodiazepines in Older Adults Tool is one of several clinical tools developed as part of the Knowledge Translation in Primary Care Initiative. This multi-year initiative was a collaboration between the Centre for Effective Practice, Ontario College of Family Physicians, and Nurse Practitioners’ Association of Ontario. Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.

Clinical Lead

  • Dr. Felicia Presenza

    BSC, MD, CCFP (COE)

    Dr. Felicia Presenza is a care of the elderly physician working in Sudbury, ON. She works at St. Joseph’s Continuing Care Centre on the rehab floor, and also provides dementia care at memory clinics. She has a geriatric-focused family practice and is faculty with The Review Course helping family medicine residents prepare for their CCFP exam.

Clinical Working Group

A clinical working group comprised of nurse practitioners and a family physician oversaw the development of this tool. Members include:

  • Jane Cox, family physician
  • Debora Steele, nurse practitioner
  • Shelly Christensen, nurse practitioner

Thank you to all of our members for their work!

Target End User Feedback and Expert Opinion

We also sought target end user and expert input to inform the content and would like to thank these individuals for their time and expertise.


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