Hospital-based identification and preparation of a personalized tapering program for long-term hypnosedative use in older adults with insomnia: feasibility and barriers.

内容摘要

This pilot study evaluated the feasibility of hospital-based identification and preparation for a personalised, multidisciplinary tapering programme for long-term hypnosedative use in older adults with insomnia, focusing on implementation processes and patient-reported barriers rather than clinical efficacy. This single-centre, prospective, interventional pilot study was conducted at Ghent University Hospital (Belgium). Patients aged ≥70 years using ≥1 hypnosedative for insomnia for ≥90 consecutive days were screened. Eligible participants received either a reimbursed tapering scheme or an individual tapering plan which was initiated after discharge. Both were developed collaboratively with the patient, hospital physicians, clinical pharmacist, general practitioner, and community pharmacist. Follow-up telephone interviews at four and twelve weeks assessed tapering adherence, self-reported barriers, fall incidents, and sleep quality. Among 2860 screened patients, 30 were included (median age 77 years; 50% Male; 93.3% polypharmacy). At 12 weeks, 23.1% were actively tapering, and 19.2% had fully discontinued hypnosedatives. The most frequently reported barriers involved reflective motivation (62.9%), including (fear of) worsening sleep and deterioration in physical or mental health. Social opportunity barriers (22.8%) included limited support from healthcare professionals. Structural barriers included missing prescriptions and incomplete discharge instructions. Deprescribing hypnosedatives in older patients within a hospital setting is complex and challenged by low recruitment, motivational, social, and structural barriers. Multidisciplinary strategies, education, and integrated care pathways are essential to enhance implementation. Policy measures, including broader reimbursement and shared electronic medication records could further facilitate safe deprescribing interventions.