title: Benzodiazepine Initiation and Dose Escalation.
abstract: BACKGROUND
  Benzodiazepines (BZDs) place patients at a significant risk of falling. The current literature does not address if this risk is increased during initiation or dose escalations of BZDs.
  
  
  OBJECTIVE
  To determine if initiation or dose escalations of BZD regimens are associated with an increased risk of falls in hospitalized patients compared with patients maintained on their home dose or who had their dose decreased from baseline.
  
  
  METHODS
  This retrospective case-control study evaluated hospitalized patients aged 45 years or older who received a BZD. Patients who did not fall were collected in a 3:1 ratio to patients who fell. Comparisons were made between BZD regimens prior to admission and those 48 hours prior to the index date. The date of fall served as the index date for patients who fell, and the median time-to-fall served as the index date for all other patients.
  
  
  RESULTS
  A total of 132 patients were included in the study (33 falls and 99 without a fall). No significant differences were noted in demographics, baseline mobility, or past medical history. Patients who fell had a significantly longer median length of stay (15 vs 10 days; P = 0.025). Additionally, patients who fell were more likely to have had their BZD regimen initiated or dose escalated compared with patients who did not fall (63.6% vs 41.4%; P = 0.043).
  
  
  CONCLUSIONS
  The risk of falling while on a BZD is increased on initiation and dose escalations. Hospitals should ensure judicious use of BZDs in inpatients to reduce the risk of falls.
authors.affiliation: 1 Manchester University College of Pharmacy, Natural and Health Sciences, Fort Wayne, IN, USA.|2 St Vincent Indianapolis Hospital, Indianapolis, IN, USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Skinner
authors.affiliation: 2 St Vincent Indianapolis Hospital, Indianapolis, IN, USA.
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Johnston
authors.affiliation: 2 St Vincent Indianapolis Hospital, Indianapolis, IN, USA.|3 Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Saum
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk
chemical_list: D001569:Benzodiazepines
keywords: adult medicine; benzodiazepines; drug safety; general medicine; medication safety