Laurie Jacobs, MD
Chief, Einstein-Montefiore Division of Geriatrics
Claudene George, MD, RPh
Older adults have been found to have greater sensitivity at given concentrations of sedative-hypnotic medications. Psychotropic drugs have been linked to increased adverse effects in older adults, especially falls. Appropriate prescribing and monitoring is essential.
Using Clinical Looking GlassTM, a healthcare application that provides patient data for use in examining existing treatment results and formulating quality improvement strategies, Drs. Jacobs and George identified physicians' prescribing patterns of sedative-hypnotic medications for adults aged 65 years and older who received primary care at one of Montefiore Medical Center's internal medicine or family medicine ambulatory clinical sites. Additionally, they reviewed charts of all patients over 65 who were prescribed antipsychotic medications at the Moses Division's Emergency Department, with careful attention to patient characteristics, medication dosages, reasons for use, and lengths of stay.
This research resulted in the creation of an educational brochure for interdisciplinary staff, "Use of Sedative Hypnotics in Older Adults." The brochure, intended to advise and support practicing physicians in the judicious use of sedative-hypnotic medications, is distributed throughout Montefiore Medical Center and available online via the Portal of Geriatric Online Education (www.pogoe.org).
"Use of Sedative Hypnotics in Older Adults" discusses multiple aspects of prescribing psychotropic medications for elderly patients:
- recommended uses
- side effects
- medication selection
- duration of use
- risks vs. benefits of benzodiazepines, benzodiazepine receptor agonists, barbiturates, and medications affecting GABA function