Brief intervention for inappropriate z-hypnotics use in older adults: a before and after intervention study in primary care.

BACKGROUND

Z-hypnotics are commonly prescribed for insomnia, but their use in older adults is associated with an increased risk of adverse events.

AIM: We examined the long-term effect of brief intervention (BI) for inappropriate z-hypnotic use, where the control group crossed over to receive the BI 6 months after baseline.

DESIGN AND

SETTING

A before-and-after intervention study was conducted in general practice. Older patients received the BI from trained general practitioners.

METHOD: The BI group and the business-as-usual (BAU) group received the intervention with a six-month delay. The primary outcome: proportion of participants without inappropriate z-hypnotic use (≥4 weeks of use, ≥3 times per week). Secondary outcomes: the Global Sleep Assessment Questionnaire (GSAQ), pain visual analogue scale (VAS), Montreal Cognitive Assessment (MOCA), and Hospital Anxiety and Depression Scale (HADS). Patients were assessed at baseline, 6 weeks, 6 months, and 12 months.

RESULTS

We included 45 patients (31 female, mean age 69.4 years) and 21 GPs in the study. We found a significant reduction in inappropriate z-hypnotic use from baseline (68.9%) to post-treatment (27.78%), OR = 0.16, 95% CI: 0.04, 0.65, p = 0.01. GSAQ-insomnia score stayed low throughout the study. At 6 months, no participant reported insomnia. HADS was significantly reduced from baseline (mean 10.1) to post-intervention (mean 7.3, Cohen's d = -0.44, p < 0.01), whereas MOCA and VAS pain did not change significantly from baseline to post-intervention.

CONCLUSION

The proportion of patients with inappropriate z-hypnotic use decreased after BI without negatively affecting sleep, mood, pain, or cognitive function..

TRIAL REGISTRATION: clinicaltrials.gov (NCT06032715).