TORONTO — A campaign to reduce inappropriate use of health care in Canada is calling for more prudent prescribing of sleep aids among seniors.
Choosing Wisely Canada says about one third of people over age 65 are using sleeping pills, even though the drugs are particularly risky for older adults.
The group says that what’s more, the pills don’t offer substantially longer or better quality sleep.
The chairwoman of the campaign, Dr. Wendy Levinson, says there are safer ways for seniors to get more sleep.
The recommendation is one of dozens Levinson’s group is releasing aimed at educating patients and doctors about inappropriate use of health care.
Levinson says the goal is to get both sides of that dynamic to understand that some commonly ordered tests and procedures are often used unnecessarily.
“People think more is better. Patients think that they need testing and they don’t understand that testing can actually be … harmful,” Levinson said in an interview.
“Sixty per cent of doctors say that they over-ordered tests that they think are not needed at all because patients request them. So that’s MRIs or X-rays for lower back pain, it’s antibiotics when they’re not needed.”
The Choosing Wisely campaign involves more than two dozen medical specialty groups and associations which have drawn up Top 5 lists of tests, procedures or practices common to their specialty that really ought not be done. Suggested by members of the specialty, the items on the list were subjected to an evidence review to determine that it was indeed safe to urge doctors and patients to avoid this or reduce the frequency of that.
Examples including ordering a panel of blood tests every year as part of an annual physical, even for patients with no particular risk factors for the conditions for which they are being screened. In fact, the group advises against annual checkups, saying physicals are important but should be done on a more sporadic basis.
Levinson says another recommendation is that doctors not order bone density tests more frequently than every two years, because bone density doesn’t change that fast.
“Thirty per cent of the bone density (tests) in Ontario were ordered within two years,” she notes. “That’s a staggering number.”
On the issue of sleeping pills for seniors, the group points out the potential side-effects of the pills pose real risks to older adults. They include next-day drowsiness, increased risk of car accidents, constipation, trouble urinating and falls and hip fractures.
“The ads may promise lots of blissful sleep, but studies show those who use sleeping pills only sleep a little longer and better than those who don’t,” Levinson says.
“Seniors and their doctors should look hard at non-drug treatments just as they should be holding healthy conversations generally about unnecessary testing and treatment.”
Alternatives measures to improve sleep include regular exercise and avoiding consumption of caffeine after 3 p.m. or even earlier.
The Choosing Wisely campaign started in the United States and was brought to Canada by Levinson, who was a member of the U.S. campaign’s board. The work here has garnered international attention, with a number of other countries starting their own Choosing Wisely programs.
Levinson says the OECD — the Paris-based Organization for Economic Co-operation and Development — is watching the program and planning to incorporate measures of the efficacy of the efforts into its assessments of member states’s health-care systems.
Closer to home, the program is also leading to change, Levinson says.
She notes that Toronto’s North York General Hospital has embedded the recommendations into its electronic ordering system. As a result, any doctor on the system who orders something advised against by Choosing Wisely — sleeping pills for a patient who is over 65, for example — would get a notice that the program advises against that drug, test or procedure for that particular patient.