title: Zolpidem is independently associated with increased risk of inpatient falls.
abstract: BACKGROUND
  Inpatient falls are associated with significant morbidity and increased healthcare costs. Zolpidem has been reported to decrease balance and is associated with falls. Yet, it is a commonly used hypnotic agent in the inpatient setting. Zolpidem use in hospitalized patients may be a significant and potentially modifiable risk factor for falling.
  
  
  OBJECTIVE
  To determine whether inpatients administered zolpidem are at greater risk of falling.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Adult non-intensive care unit (non-ICU) inpatients at a tertiary care center.
  
  
  METHODS
  Adult inpatients who were prescribed zolpidem were identified. Electronic medical records were reviewed to capture demographics and other risk factors for falls. The fall rate was compared in those administered zolpidem versus those only prescribed zolpidem. Multivariate analyses were performed to determine whether zolpidem was independently associated with falls.
  
  
  RESULTS
  The fall rate among patients who were prescribed and received zolpidem (n = 4962) was significantly greater than among patients who were prescribed but did not receive zolpidem (n = 11,358) (3.04% vs 0.71%; P < 0.001). Zolpidem use continued to remain significantly associated with increased fall risk after accounting for age, gender, insomnia, delirium status, dose of zolpidem, Charlson comorbidity index, Hendrich's fall risk score, length of hospital stay, presence of visual impairment, gait abnormalities, and dementia/cognitive impairment (adjusted odds ratio [OR] 4.37, 95% confidence interval [CI] = 3.34-5.76; P < 0.001). Additionally, patients taking zolpidem who experienced a fall did not differ from other hospitalized adult patients who fell in terms of age, opioids, antidepressants, sedative-antidepressants, antipsychotics, benzodiazepine, or antihistamine use.
  
  
  CONCLUSIONS
  Zolpidem use was a strong, independent, and potentially modifiable risk factor for inpatient falls.
authors.affiliation: Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Bhanu Prakash
authors.initials: BP
authors.lastname: Kolla
authors.forename: Jenna K
authors.initials: JK
authors.lastname: Lovely
authors.forename: Meghna P
authors.initials: MP
authors.lastname: Mansukhani
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D017677:Age Distribution; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D002492:Central Nervous System Depressants / Q000008:administration & dosage / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007297:Inpatients / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D004856:Postural Balance / Q000187:drug effects*; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000139:chemically induced; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D000077334:Zolpidem
chemical_list: D000701:Analgesics, Opioid; D002492:Central Nervous System Depressants; D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem