The patient is a 71-year-old widowed man who is seen regularly in the clinic for health maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for

The patient is a 71-year-old widowed man who is seen regularly in the clinic for health maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for triazolam (Halcion) and clonazepam (Klonopin) for these problems. Recently he has been reporting frequent episodes of losing his balance and falling, and eight weeks ago was hospitalized for a hip fracture sustained during one of these falls resulting in hip surgery. On this visit, he also complains of becoming increasingly confused.

• What information would be most critical for you to collect in the first visit?
• What is the primary goal for the treatment of this patient?
• Identify potential obstacles for change.  Which educational approach would the PMHNP provide to overcome these obstacles?
• How would you teach the patient about the Beers list and Halcion? 
• Discuss a medication in detail that could be safely substituted to treat insomnia in geriatric patients.

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