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Use of Benzodiazepines and Association with Falls in Older People Admitted to Hospital: A Prospective Cohort Study

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Abstract

Background

Hypnosedatives are commonly prescribed for anxiety and sleep problems. Changes in pharmacokinetics and pharmacodynamics of benzodiazepines (BZDs) during ageing may increase their potential to cause adverse outcomes.

Objective

This study aimed to investigate the use of BZDs in acute care settings and explore their association with falls.

Methods

A prospective cohort study was undertaken of patients aged over 70 years consecutively admitted to 11 acute care hospitals in Australia. Data were collected using the interRAI Acute Care assessment tool. Falls were recorded prospectively (in hospital) and retrospectively (in the 90 days prior to admission).

Results

Of 1,412 patients, 146 (10.3 %) were taking BZDs at admission and 155 (11.3 %) at discharge. Incidence rates of in-hospital fallers for users and non-users of BZDs were not statistically different [incidence rate ratio 1.03, 95 % confidence interval (CI) 0.58–1.82]. There was also no significant association between benzodiazepine use at admission and history of falls in the previous 90 days compared with non-users. However, patients on diazepam were significantly more likely to have a history of falls than all other benzodiazepine users (70.8 vs. 36.1 %; p = 0.002), particularly when compared with oxazepam users (70.8 vs. 25.0 %; p < 0.001). Adjusting for confounders, use of diazepam at admission was positively associated with a history of falls compared with all other benzodiazepine users (odds ratio 3.0; 95 % CI 1.1–8.5; p = 0.036).

Conclusions

Different BZDs may vary in their propensity to predispose to falls, with diazepam having the strongest association. The selection of particular BZDs for older patients should be carefully evaluated.

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Acknowledgments

The preparation of this manuscript was funded by the Princess Alexandra Hospital Private Practice Trust Fund Research Support Grants scheme, and MID-FRAIL-HEALTH-F2-2012-278803, PRVOUK P40/faf/2013

Anna Ballokova, Nancye M. Peel, Daniela Fialova, Ian A. Scott, Leonard C. Gray and Ruth E. Hubbard have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University in Prague, Londýnská 15, 128 08, Prague, Czech Republic

    Anna Ballokova & Daniela Fialova

  2. Centre for Research in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, QLD, Australia

    Nancye M. Peel, Leonard C. Gray & Ruth E. Hubbard

  3. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Prague, Czech Republic

    Daniela Fialova

  4. School of Medicine, The University of Queensland, Brisbane, QLD, Australia

    Ian A. Scott

  5. Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, QLD, Australia

    Ian A. Scott

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  1. Anna Ballokova
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Correspondence to Anna Ballokova.

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Ballokova, A., Peel, N.M., Fialova, D. et al. Use of Benzodiazepines and Association with Falls in Older People Admitted to Hospital: A Prospective Cohort Study. Drugs Aging 31, 299–310 (2014). https://doi.org/10.1007/s40266-014-0159-3

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