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. 2014 Jul 1;3(3):158.
doi: 10.4172/2167-7182.1000158.

Use of non-benzodiazepine sedative hypnotics and risk of falls in older men

Susan J Diem  1 , Susan K Ewing  2 , Katie L Stone  2 , Sonia Ancoli-Israel  3 , Susan Redline  4 , Kristine E Ensrud  5 ; the Osteoporotic Fractures in Men (MrOS) Study Group
Affiliations

Use of non-benzodiazepine sedative hypnotics and risk of falls in older men

Susan J Diem et al. J Gerontol Geriatr Res. .

Abstract

Background: To ascertain whether use of non-benzodiazepine sedative-hypnotics is associated with risk of falls and compare this to risk of falls associated with use of benzodiazepines.

Methods: Among 4450 community-dwelling men, aged 71 years and older, enrolled in the population-based prospective cohort study, Osteoporotic Fractures in Men (MrOS), use of nonbenzodiazepine sedative-hypnotics and benzodiazepines was assessed by interview and verified from medication containers at the third annual visit of the MrOS study. Falls in the subsequent one-year period were ascertained by tri-annual questionnaires and a computerized dictionary used to categorize type of medication.

Results: In age-adjusted models, non-benzodiazepine sedative hypnotic use was associated with an increased risk of any falls (one or more falls) (RR 1.44, 95% CI 1.15, 1.81) and recurrent falls (2 or more falls) (RR 1.51, 95% CI 1.07, 2.14). Use of benzodiazepines was associated with a similar increase in age-adjusted risk of falling. Depressive symptoms, inability to stand from a chair, and instrumental activities of daily living (IADL) impairment modestly attenuated these associations. The association between non-benzodiazepine sedative-hypnotic use and falls was most pronounced among men without a history of falls in the previous year: in a multivariable model controlling for multiple potential confounders, the RR of any falls was 1.74 (95% CI 1.13, 2.68) in this subgroup.

Conclusions: Use of non-benzodiazepine sedative-hypnotics is associated with an increased risk of falls. Non-pharmacologic approaches to sleep disturbances may represent the safest approach to sleep difficulties in older adults.

Keywords: adverse drug effects; benzodiazepines; falls; men; sedative hypnotics; zolpidem.

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Figures

Figure 1a-b
Figure 1a-b. Association between Non-benzodiazepine Sedative-hypnotic use, Benzodiazepine Use and Risk of Falls
*model adjusted for age, site, GDS score, educational status, BMI, comorbidity index, ability to stand from a chair, PASE score, self-reported health status, IADL impairments, alcohol use, and MMSE. Abbreviations: IADL, Instrumental Activities of Daily Living; MMSE, Mini-Mental State Examination; GDS, Geriatric Depression Scale; BMI, body mass index; PASE, Physical Activity Scale for the Elderly
Figure 1a-b
Figure 1a-b. Association between Non-benzodiazepine Sedative-hypnotic use, Benzodiazepine Use and Risk of Falls
*model adjusted for age, site, GDS score, educational status, BMI, comorbidity index, ability to stand from a chair, PASE score, self-reported health status, IADL impairments, alcohol use, and MMSE. Abbreviations: IADL, Instrumental Activities of Daily Living; MMSE, Mini-Mental State Examination; GDS, Geriatric Depression Scale; BMI, body mass index; PASE, Physical Activity Scale for the Elderly
Figure 2
Figure 2. Association between Non-benzodiazepine Sedative-hypnotic Use and Risk of Falls among men without a history of falls
*model adjusted for age, site, GDS score, educational status, BMI, comorbidity index, ability to stand from a chair, PASE score, self-reported health status, IADL impairments, alcohol use, and MMSE. Abbreviations: IADL, Instrumental Activities of Daily Living; MMSE, Mini-Mental State Examination; GDS, Geriatric Depression Scale; BMI, body mass index; PASE, Physical Activity Scale for the Elderly
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