Call me nuts, but I want to talk more about sleeping pill use. associated with psychiatric medications in general, and zolpidem — Ambien — in particular. “When you're talking about falls and fractures, it's the same effect….
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visits annually because of adverse reactions, the study found; more than 19 percent of those visits result in hospital admissions. Now the C.D.C. has reported that a high number of emergency room visits are associated with psychiatric medications in general, and zolpidem — Ambien — in particular. They’re implicated in 90,000 adult E.R.
visits among those older than 65, more than any other medication. The data also showed that Ambien, the use of which has soared in recent years, accounted for one in five E.R.
The physicians I consulted urged patients to seek a comprehensive evaluation, possibly including sleep studies, and then try nonpharmacological remedies first, turning to sleeping pills only after exhausting the alternatives. JAMA published a patient guide to treating insomnia last year. Yet those remedies — changing sleep habits, seeking cognitive behavioral therapy — have been found to be effective against insomnia.
“I didn’t expect a single drug to stand out that much,” Dr. Hampton said. That may be because Medicare didn’t cover benzodiazepines but did cover zolpidem from the inception of Part D in 2003 until last year, when the policy changed.
Read more…. Circumstances had changed, and all these documents needed to change, too.
Tannenbaum and colleagues sent patients? In their study, which looked only at benzodiazepine use, the brochure urged recipients to consult health care professionals before embarking on detoxification. Can patients gradually wean themselves from sedatives, using a chart like the one in the brochure Dr.
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“And there were also a lot of falls.”. Among those taking sedatives and anxiety-reducing drugs, “a lot of visits were because people were too sleepy or hard to arouse, or confused,” said the lead author, Dr. Lee Hampton, a medical officer at the C.D.C.
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Tannenbaum concurred. “When you’re talking about falls and fractures, it’s the same effect….The risks are the same.” Dr. But as sleeping pills, “I wouldn’t consider them distinct at all,” Dr. Gurwitz said of the benzos and Z-drugs.
A 65-year-old speedwalker has a different risk profile from an 85-year-old with poor vision or osteoporosis. A final caveat: Yes, older people are different.
The Food and Drug Administration, concerned about “next-morning impairment” from Ambien, last year halved the recommended dose for women, to 5 milligrams from 10 milligrams, and to 6.25 milligrams from 12.5 milligrams for extended-release versions like Ambien CR.
“Things that take longer and require more conversation are used less.”. “Often in medicine, the quickest and easiest thing doctors can do is write a prescription,” Dr. Hampton said.
First, for those who objected to collectively referring to benzo and non-benzo sedatives and “not honoring the differences” between them, as Kathy from Hawaii said.
Dementia doesn't respect public stature.
Older patients, it turns out, did not show up more often in emergency rooms because of adverse reactions to sedatives and antianxiety drugs. People ages 19 to 44 have the highest number of visits in proportion to prescriptions for those medicines. The C.D.C. looked at visits by drug and by age.
On to some other questions readers raised.
The New Old Age will run as a twice-monthly column by Paula Span on nytimes.com and frequently in Science Times. Read more…. The blog is ending, but our coverage of caregiving and aging is not.
from New York City demanded. Did doctors (or did I) consider them unable to make rational drug decisions? “Is it that older people are less important, full stop?” reader L. The data also answer questions readers here raised about whether older adults were being singled out.
Jerry H. “And high on the list of those medications related to falls and fall-related injuries are sedative-hypnotics.”. “There’s a conslation of risks that contribute to falls, and medications are clearly part of it,” said Dr. Gurwitz, a geriatrician at the University of Massachusetts Medical School who has studied drug safety in older people.
Hold your fire for a few paragraphs, please.
I say “reinforce” because geriatricians and other physicians have fretted for years about the use of sedative-hypnotic medications, including benzodiazepines (like Ativan, Klonopin, Xanax and Valium) and the related “Z-drugs” (like Ambien) for treating insomnia.
A version of this article appears in print on 08/05/2014, on page D 5 of the NewYork edition with the headline: Trips to E.R. Tied to Use of Sedatives.
In 2013, the American Geriatrics Society put sedative-hypnotics on its first Choosing Wisely campaign list of “Five Things Physicians and Patients Should Question,” citing heightened fall and fracture risks and automobile accidents in older patients who took them.
About a third of those older than 65 (32 percent) who went to E.R.s with adverse responses to sedatives were hospitalized, compared with about 13 percent of those 19 to 44 (and 27.2 percent of those 45 to 64). But the consequences were worse for older people.
A few medical institutions have opened their doors to patients’ own dogs and cats.
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“I haven’t prescribed a sedative-hypnotic in 15 years.”. Cara Tannenbaum, the geriatrician at the University of Montreal who led the weaning study. “I’m not comfortable writing a prescription for these medications,” said Dr.
Just a week after I posted here about medical efforts to help wean older patients off sleeping pills — causing a flurry of comments, many taking exception to the whole idea as condescending or dismissive of the miseries of insomnia — researchers at the Centers for Disease Control and Prevention and Johns Hopkins published findings that reinforce concerns about these drugs.
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Thanks to the marvels of medical science, our parents are living longer than ever before. Most will spend years dependent on others for the most basic needs. The New Old Age blog explored this unprecedented intergenerational challenge. That burden falls to their baby boomer children. Paula Span will continue to write New Old Age columns twice monthly at nytimes.com/health and the conversation will continue on Twitter ( @paula_span ) and Facebook.
But the physicians I consulted couldn’t countenance extended sedative use, even for the former.
The Z-drugs are approved only as sleep aids. Benzodiazepines have other uses, like treating panic disorders or seizures; some people may be taking them throughout the day, not only at bedtime.
Call me nuts, but I want to talk more about sleeping pill use.
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Among those who didn’t make the attempt, the greatest reason — get this — was discouragement from their physicians or pharmacists. Of the group that attempted to gradually stop the drug, more than half succeeded, and another 22 percent reduced their dosage.
estimates that a third of older adults fall annually. A 2010 analysis of falls says 22 percent of “community dwelling” Medicare beneficiaries older than 65 (excluding nursing home residents) fell in a year. The other particular concern for older people is falls, a leading cause of death and disability. Twenty to 30 percent of those falls result in injuries that require medical attention. The C.D.C.