Benzodiazepines and the risk of falls in nursing home residents.

Ray WA, Thapa PB, Gideon P
J Am Geriatr Soc. 2000 48 (6): 682-5

PMID: 10855607 · DOI:10.1111/j.1532-5415.2000.tb04729.x

CONTEXT - For nursing home residents who require a benzodiazepine, short-acting agents are recommended, primarily to avoid increased risk of falls and other injuries associated with the long-acting agents. However, much of the data for the clinical outcomes of falls and injuries comes from community-dwelling older people.

OBJECTIVE - To quantify the rate of falls among nursing home residents taking benzodiazepines and how this varies with drug elimination half-life.

DESIGN - Historical cohort study.

POPULATION - A total of 2510 residents of 53 Tennessee nursing homes, classified according to benzodiazepine use on each day of follow-up.

OUTCOME MEASURES - Falls occurring during study follow-up.

RESULTS - After adjustment for differences in resident characteristics, benzodiazepine users had a 44% increased rate of falls (adjusted rate ratio 1.44 [95% confidence interval, 1.33-1.56]). The adjusted rate ratio increased from 1.30 (1.12-1.52) for a dose equivalent to < or = 2 mg of diazepam, to 2.21 (1.89-2.60, P < .001) for a dose of > 8 mg. The rate of falls was greatest in the 7 days after the benzodiazepine was started (rate ratio of 2.96 [2.33-3.75]) but remained elevated (1.30 [1.17-1.44]) after the first 30 days of therapy. Drugs with elimination half-lives of <12, 12-23, and > or = 24 hours had adjusted rate ratios of 1.15 (0.94-1.40), 1.45 (1.33-1.59), and 1.73 (1.40-2.14), respectively. Users of hypnotics with elimination half-lives <12 hours had an increased rate of falls occurring during the night (adjusted rate ratio 2.82 [2.02-3.94]).

CONCLUSIONS - Although the risk of falls among nursing home residents receiving short-acting benzodiazepines is less than that for the long-acting agents, these drugs are associated with a materially increased risk of nocturnal falls.

MeSH Terms (15)

Accidental Falls Aged Aged, 80 and over Anti-Anxiety Agents Benzodiazepines Follow-Up Studies Frail Elderly Half-Life Homes for the Aged Humans Nursing Homes Poisson Distribution Regression Analysis Risk Factors Tennessee

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