Knowledge, attitudes, and physician engagement among hospitalized older adults using long-term sedative-hypnotics

Sedative-hypnotics remain widely used in older adults despite safety concerns. We conducted a cross-sectional interviewer-administered survey of hospitalized patients ≥65 years with regular sedative-hypnotic use documented on admission to characterize use, knowledge of recommended duration and adverse effects, and clinician engagement in counseling and deprescribing. Among 88 participants (mean age 81.5; 60% women), only 18% reported any counseling on duration and/or adverse effects, and 1% were offered a nonpharmacological alternative. Deprescribing engagement was limited: 7% reported that a physician had offered stopping and 19% had tried to stop; fear of stopping was common (88%). Nevertheless, 35% said they would try to discontinue if their physician advised that they could stop, and 32% reported abnormal events since starting treatment. These exploratory findings suggest a potentially actionable care gap. Structured counseling, shared decision-making, deprescribing support, and access to behavioral insomnia therapies warrant prospective evaluation as strategies to improve sedative-hypnotic safety in older adults.