Understanding 'embedded pharmaceuticalisation': A case study of sleeping medication use in later life

Area of Science:

• Sociology
• Gerontology
• Pharmaceutical Studies

Background:

• Sleeping medication use in older adults is associated with adverse effects like falls and cognitive decline.
• Despite guidelines for reduced prescribing, long-term use remains common among seniors.
• Sociological studies reveal ambivalence and unease regarding sleep aid dependency in later life.

Purpose of the Study:

• To explore the reasons behind the persistent long-term use of sleeping medications in older adults.
• To understand how sleeping medication use becomes embedded in the lives of elderly individuals.
• To investigate the interplay between emotional needs, perceived necessity, and continued reliance on sleep aids.

Main Methods:

• Qualitative study involving interviews and diaries with 38 UK adults aged 65 and older.
• Average duration of sleeping medication use among participants was 17 years.
• Analysis focused on understanding the persistence of use despite expressed concerns.

Main Results:

• Participants expressed moral concerns but prioritized a profound emotional need for sleep.
• Sleeping medication was viewed as the sole effective remedy, leading to 'embedded pharmaceuticalisation'.
• Users employed active (sourcing, stockpiling) and passive (avoiding reviews) strategies to sustain use, driven by necessity and habit.

Conclusions:

• Long-term sleeping medication use in older adults is sustained by a process of 'embedded pharmaceuticalisation', where medication becomes integral to emotional life and identity.
• The perceived necessity and emotional reliance on sleep aids outweigh expressed desires to reduce or avoid them.
• Understanding these trajectories is crucial for addressing the persistence of medication use beyond initial prescribing.