Benzodiazepines and the risk of falls in nursing home residents.
BACKGROUND
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.


METHODS
Historical cohort study.


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


METHODS
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.
Ray
W A
WA
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
Thapa
P B
PB
Gideon
P
P
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D001569:Benzodiazepines; D005500:Follow-Up Studies; D016330:Frail Elderly; D006207:Half-Life; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D016012:Poisson Distribution; D012044:Regression Analysis; D012307:Risk Factors; D013714:Tennessee
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines