Benzodiazepines and Injurious Falls in Community Dwelling Elders
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Benzodiazepines are frequently used medications in the elderly, in whom they are associated with an increased risk of falling, with sometimes dire consequences.
To estimate the impact of benzodiazepine-associated injurious falls in a population of elderly persons.
A nested case-control study was conducted using data collected during 10 years of follow-up of the French PAQUID (Personnes Agées QUID) community-based cohort. The main outcome measure was the occurrence of an injurious fall, which was defined as a fall resulting in hospitalization, fracture, head trauma or death. Controls (3:1) were frequency-matched to cases. Benzodiazepine exposure was the use of benzodiazepines over the previous 2 weeks reported at the follow-up visit preceding the fall.
Benzodiazepine use was significantly associated with the occurrence of injurious falls, with a significant interaction with age. The adjusted odds ratio for injurious falls in subjects exposed to benzodiazepines was 2.2 (95% CI 1.4, 3.4) in subjects aged ≥80 years and 1.3 (95% CI 0.9, 1.9) in subjects aged <80 years. The population attributable risk for injurious falls in subjects exposed to benzodiazepines was 28.1% (95% CI 16.7, 43.2) for subjects aged ≥80 years. The incidence of injurious falls in subjects aged ≥80 years exposed to benzodiazepines in the PAQUID cohort was 2.8/100 person-years. Over 9% of these falls were fatal. According to these results and to recent population estimates, benzodiazepine use could be held responsible for almost 20 000 injurious falls in subjects aged ≥80 years every year in France, and for nearly 1800 deaths.
Given the considerable morbidity and mortality associated with benzodiazepine use and the fact that existing good practice guidelines on benzodiazepines have not been effective in preventing their misuse (possibly because they have not been applied), new methods for limiting use of benzodiazepines in the elderly need to be found.
KeywordsSleep Disorder Zolpidem Zopiclone Population Attributable Risk Index Period
The PAQUID project was funded by: Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAMTS), Conseil Général de la Dordogne, Conseil Général de la Gironde, Conseil Régional d’Aquitaine Fondation de France, France Alzheimer (Paris), Institut National de la Santé et de la Recherche Médicale (INSERM) Groupement d’Intérêt Scientifique (GIS) Longévité, Mutuelle Générale de l’Education Nationale (MGEN), Mutualité Sociale Agricole (MSA) AGRICA, Novartis Pharma (France) and Scor Insurance (France).
The funding sources had no role in the design and conduct of the study, no role in the collection, management, analysis and interpretation of the data and no role in the preparation, review and approval of the manuscript. The authors have no conflicts of interest that are directly relevant to the content of this study.
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