Benzodiazepines and the Risk of Falls in Nursing Home Residents

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Abstract
CONTEXT: For nursing home residents who require a benzodiazepine, short‐acting agents are recommended, primarily to avoid increased risk of falls and other injuries associated with the long‐acting agents. However, much of the data for the clinical outcomes of falls and injuries comes from community‐dwelling older people. OBJECTIVE: To quantify the rate of falls among nursing home residents taking benzodiazepines and how this varies with drug elimination half‐life. DESIGN: Historical cohort study. POPULATION: A total of 2510 residents of 53 Tennessee nursing homes, classified according to benzodiazepine use on each day of follow‐up. OUTCOME MEASURES: Falls occurring during study follow‐up. RESULTS: After adjustment for differences in resident characteristics, benzodiazepine users had a 44% increased rate of falls (adjusted rate ratio 1.44 [95% confidence interval, 1.33‐1.56]). The adjusted rate ratio increased from 1.30 (1.12‐1.52) for a dose equivalent to ≤2 mg of diazepam, to 2.21 (1.89‐2.60, P < .001) for a dose of > 8 mg. The rate of falls was greatest in the 7 days after the benzodiazepine was started (rate ratio of 2.96 [2.33‐3.75]) but remained elevated (1.30 [1.17‐1.44]) after the first 30 days of therapy. Drugs with elimination half‐lives of < 12, 12–23, and ≥24 hours had adjusted rate ratios of 1.15 (0.94‐1.40), 1.45 (1.33‐1.59), and 1.73 (1.40‐2.14), respectively. Users of hypnotics with elimination half‐lives < 12 hours had an increased rate of falls occurring during the night (adjusted rate ratio 2.82 [2.02–3.94]). CONCLUSIONS: Although the risk of falls among nursing home residents receiving short‐acting benzodiazepines is less than that for the long‐acting agents, these drugs are associated with a materially increased risk of nocturnal falls. J Am Geriatr Soc 48:682–685, 2000.