title: Use of non-benzodiazepine sedative hypnotics and risk of falls in older men.
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.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN ; Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Diem
authors.affiliation: California Pacific Medical Center Research Institute, San Francisco, CA.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Ewing
authors.affiliation: California Pacific Medical Center Research Institute, San Francisco, CA.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Stone
authors.affiliation: Departments of Psychiatry and Family & Preventive Medicine, University of California - San Diego, La Jolla, CA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.affiliation: Harvard Medical School, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN ; Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN ; Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
keywords: adverse drug effects; benzodiazepines; falls; men; sedative hypnotics; zolpidem