Improving Patient Safety by Supporting Older Adults in Managing Sleep Problems.

Last updated: December 2, 2024
Sponsor: Insel Gruppe AG, University Hospital Bern
Overall Status: Active - Recruiting

Phase

N/A

Condition

Narcolepsy

Sleep Disorders

Treatment

Specific tapering plan for sleep medication, educational and cognitive behavioural therapy elements

Clinical Study ID

NCT06584513
2024-00702
  • Ages > 65
  • All Genders

Study Summary

Among older adults (≥65 years), use of sleeping pills, such as benzodiazepines and other sedative-hypnotics, to treat sleep problems is common. While sleeping pills are effective in the first few weeks of use, their effect diminishes significantly after that. Especially older adults are susceptible to significant adverse effects of sleep pills, yet stopping sleeping pills remains challenging. BE-SAFE aims to conduct a randomised study testing a patient-centred intervention to reduce sleeping pill use and to improve patient safety and quality of care focusing on implementation aspects. The intervention addresses knowledge and practice gaps related to discontinuation of sleeping pills in older adults with sleep problems.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • ≥65 years old

  • BSH (ATC codes N05BA, N05CF, N05CD, and N03AE01) use on average ≥3 times a weekduring the last 3 months prior to providing informed consent, as self-reported bythe patient or by the informal carer

  • Taking BSH for sleep problems, as self-reported by the patient or by the informalcarer

Exclusion

Exclusion Criteria:

  • Indication for BSH appropriate or withdrawal dangerous, based on available documents (diagnosis list) or General Practitioner (GP) information:

  • Current use of BSH for alcohol withdrawal

  • BSH use in the context of addiction

  • Rapid Eye Movement (REM) sleep Behaviour Disorders

  • Active diagnosis of severe non-REM-related parasomnias with risk of self-damageor giving harm to others or with high frequency or social embarrassment

  • Epilepsy (all forms, because of risk of seizures by sleep deprivation)

  • Current active diagnosis of severe general or specific anxiety disorder (including obsessive compulsive disorder, social phobia, post-traumatic stressdisorder, panic disorder with or without agoraphobia)

  • Current active diagnosis of psychotic disorder with or without antipsychoticmedication

  • Current active diagnosis of severe depression with or without major anxietysymptoms

  • Current active diagnosis of bipolar disorder with or without major anxietysymptoms

  • Acute suicidal ideation

  • Current formal active tapering process of BSHs supported by a physician

  • Planned admission to palliative care within 24 hours of inclusion or estimatedlife-expectancy of less than 12 months i.e., patient is in a state or has adiagnosis where the cluster physician would not be surprised if patient dies withinthe next months (this criterion is relatively vague and subjective but because thereis no validated prognostic score, it is justified)

  • Inability to provide informed consent (e.g., because of cognitive impairment),except if a proxy can provide consent, be actively involved in the study, andpatient shows no sign of disagreement

Study Design

Total Participants: 470
Treatment Group(s): 1
Primary Treatment: Specific tapering plan for sleep medication, educational and cognitive behavioural therapy elements
Phase:
Study Start date:
November 18, 2024
Estimated Completion Date:
February 01, 2026

Study Description

Background:

Use of Benzodiazepine and Sedative Hypnotics (BSHs) is one of the three overuse practices measured by the OECD. BSH use has been reported to be as high as 15-30% in older adults with 87% taking BSHs for sleep problems. Use of BSHs is associated with significant adverse effects such as falls, fractures, hospitalisations, impaired functioning, delirium, dementia and mortality and therefore threatens patient safety. This applies especially to older adults as they are more susceptible to adverse effects due to changes in pharmacokinetics and pharmacodynamics associated with age and to the frequent presence of polypharmacy and comorbidities.

Design:

Multicenter, superiority (first co-primary endpoint) and non-inferiority (second co-primary endpoint) cluster randomised controlled trial (RCT) conducted in six countries across Europe (Belgium, Greece Norway, Poland, Spain, and Switzerland). Participating physicians will be randomly assigned in a 1:1 ratio in clusters to either the intervention group (with training and additional material to overcome sleeping problems and to help participants discontinue BSH) or the control group (treatment according to standard of care without training or additional material). Eligible patients will be enrolled with their treating physician defined as the cluster. Outcome assessment will be blinded.

Connect with a study center

  • Centre Hospitalier Universitaire CHU UCL Namur

    Yvoir, 5530
    Belgium

    Active - Recruiting

  • National and Kapodistrian University of Athens

    Athens, 10679
    Greece

    Site Not Available

  • Oslo University Hospital

    Nydalen, 4950
    Norway

    Active - Recruiting

  • Institute of Psychiatry and Neurology

    Warsaw, 02-957
    Poland

    Active - Recruiting

  • Universitat Autònoma de Barcelona

    Barcelona, 08041
    Spain

    Site Not Available

  • Department of General Internal Medicine, University Hospital Bern (Inselspital)

    Bern, 3010
    Switzerland

    Active - Recruiting

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