Advertisement

Drugs & Aging

, Volume 25, Issue 1, pp 61–70 | Cite as

Benzodiazepines and Injurious Falls in Community Dwelling Elders

  • Antoine Pariente
  • Jean-Francois Dartigues
  • Jacques Benichou
  • Luc Letenneur
  • Nicholas Moore
  • Annie Fourrier-Réglat
Original Research Article

Abstract

Background

Benzodiazepines are frequently used medications in the elderly, in whom they are associated with an increased risk of falling, with sometimes dire consequences.

Objective

To estimate the impact of benzodiazepine-associated injurious falls in a population of elderly persons.

Method

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.

Results

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.

Conclusion

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.

Keywords

Sleep Disorder Zolpidem Zopiclone Population Attributable Risk Index Period 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

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.

References

  1. 1.
    Nowell PD, Mazumdar S, Buysse DJ, et al. Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy. JAMA 1997 Dec 24–31; 278(24): 2170–7PubMedCrossRefGoogle Scholar
  2. 2.
    Shorr RI, Robin DW. Rational use of benzodiazepines in the elderly. Drugs Aging 1994 Jan; 4(1): 9–20PubMedCrossRefGoogle Scholar
  3. 3.
    Corman B, Leger D. Sleep disorders in elderly. Rev Prat 2004 Jun 30; 54(12): 1281–5PubMedGoogle Scholar
  4. 4.
    Holbrook AM, Crowther R, Lotter A, et al. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ 2000 Jan 25; 162(2): 225–33PubMedGoogle Scholar
  5. 5.
    Glass J, Lanctot KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005 Nov 19; 331(7526): 1169–75PubMedCrossRefGoogle Scholar
  6. 6.
    Agence Française de Securite Sanitaire des Produits de Sante (AFSSaPS). Références médicales opposables n∘4. Prescription des hypnotiques et des anxiolytiques [online]. Available from URL: http://agmed.sante.gouv.fr/htm/5/5200c.htm#4.anxio/ [Accessed 2007 Nov 14]
  7. 7.
    Lagnaoui R, Depont F, Fourrier A, et al. Patterns and correlates of benzodiazepine use in the French general population. Eur J Clin Pharmacol 2004 Sep; 60(7): 523–9PubMedCrossRefGoogle Scholar
  8. 8.
    Lechevallier N, Fourrier A, Berr C. Benzodiazepine use in the elderly: the EVA Study. Rev Epidemiol Sante Publique 2003 Jun; 51(3): 317–26PubMedGoogle Scholar
  9. 9.
    Conn DK, Madan R. Use of sleep-promoting medications in nursing home residents: risks versus benefits. Drugs Aging 2006; 23(4): 271–87PubMedCrossRefGoogle Scholar
  10. 10.
    Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc 2002 Oct; 50(10): 1629–37PubMedCrossRefGoogle Scholar
  11. 11.
    Tromp AM, Pluijm SM, Smit JH, et al. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001 Aug; 54(8): 837–44PubMedCrossRefGoogle Scholar
  12. 12.
    Herings RM, Stricker BH, de Boer A, et al. Benzodiazepines and the risk of falling leading to femur fractures: dosage more important than elimination half-life. Arch Intern Med 1995 Sep 11; 155(16): 1801–7PubMedCrossRefGoogle Scholar
  13. 13.
    Lichtenstein MJ, Griffin MR, Cornell JE, et al. Risk factors for hip fractures occurring in the hospital. Am J Epidemiol 1994 Nov 1; 140(9): 830–8PubMedGoogle Scholar
  14. 14.
    Mustard CA, Mayer T. Case-control study of exposure to medication and the risk of injurious falls requiring hospitalization among nursing home residents. Am J Epidemiol 1997 Apr 15; 145(8): 738–45PubMedCrossRefGoogle Scholar
  15. 15.
    Panneman MJ, Goettsch WG, Kramarz P, et al. The costs of benzodiazepine-associated hospital-treated fall injuries in the EU: a Pharmo study. Drugs Aging 2003; 20(11): 833–9PubMedCrossRefGoogle Scholar
  16. 16.
    French DD, Werner DC, Campbell RR, et al. A multivariate fall risk assessment model for VHA nursing homes using the minimum data set. J Am Med Dir Assoc 2007 Feb; 8(2): 115–22PubMedCrossRefGoogle Scholar
  17. 17.
    Koski K, Luukinen H, Laippala P, et al. Risk factors for major injurious falls among the home-dwelling elderly by functional abilities: a prospective population-based study. Gerontology 1998; 44(4): 232–8PubMedCrossRefGoogle Scholar
  18. 18.
    Koski K, Luukinen H, Laippala P, et al. Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. Age Ageing 1996 Jan; 25(1): 29–38PubMedCrossRefGoogle Scholar
  19. 19.
    Souchet E, Lapeyre-Mestre M, Montastruc JL. Drug related falls: a study in the French Pharmacovigilance database. Pharmacoepidemiol Drug Saf 2005 Jan; 14(1): 11–6PubMedCrossRefGoogle Scholar
  20. 20.
    Kelly KD, Pickett W, Yiannakoulias N, et al. Medication use and falls in community-dwelling older persons. Age Ageing 2003 Sep; 32(5): 503–9PubMedCrossRefGoogle Scholar
  21. 21.
    Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 2003 Sep 27; 327(7417): 712–7PubMedCrossRefGoogle Scholar
  22. 22.
    Pierfitte C, Macouillard G, Thicoipe M, et al. Benzodiazepines and hip fractures in elderly people: case-control study. BMJ 2001 Mar 24; 322(7288): 704–8PubMedCrossRefGoogle Scholar
  23. 23.
    de Rekeneire N, Visser M, Peila R, et al. Is a fall just a fall: correlates of falling in healthy older persons. The Health, Aging and Body Composition Study. J Am Geriatr Soc 2003 Jun; 51(6): 841–6PubMedCrossRefGoogle Scholar
  24. 24.
    Ensrud KE, Blackwell T, Mangione CM, et al. Central nervous system active medications and risk for fractures in older women. Arch Intern Med 2003 Apr 28; 163(8): 949–57PubMedCrossRefGoogle Scholar
  25. 25.
    Kron M, Loy S, Sturm E, et al. Risk indicators for falls in institutionalized frail elderly. Am J Epidemiol 2003 Oct 1; 158(7): 645–53PubMedCrossRefGoogle Scholar
  26. 26.
    Tinetti ME, Doucette J, Claus E, et al. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995 Nov; 43(11): 1214–21PubMedGoogle Scholar
  27. 27.
    Dargent-Molina P, Favier F, Grandjean H, et al. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 1996 Jul 20; 348(9021): 145–9PubMedCrossRefGoogle Scholar
  28. 28.
    Kannus P, Niemi S, Palvanen M, et al. Fall-induced injuries among elderly people. Lancet 1997 Oct 18; 350(9085): 1174PubMedCrossRefGoogle Scholar
  29. 29.
    Luukinen H, Koski K, Honkanen R, et al. Incidence of injurycausing falls among older adults by place of residence: a population-based study. J Am Geriatr Soc 1995 Aug; 43(8): 871–6PubMedGoogle Scholar
  30. 30.
    Dartigues JF, Gagnon M, Barberger-Gateau P, et al. The Paquid epidemiological program on brain ageing. Neuroepidemiology 1992; 11Suppl. 1: 14–8PubMedCrossRefGoogle Scholar
  31. 31.
    Wacholder S, McLaughlin JK, Silverman DT, et al. Selection of controls in case-control studies: I. Principles. Am J Epidemiol 1992 May 1; 135(9): 1019–28PubMedGoogle Scholar
  32. 32.
    Wacholder S, Silverman DT, McLaughlin JK, et al. Selection of controls in case-control studies: III. Design options. Am J Epidemiol 1992 May 1; 135(9): 1042–50PubMedGoogle Scholar
  33. 33.
    Wacholder S, Silverman DT, McLaughlin JK, et al. Selection of controls in case-control studies: II. Types of controls. Am J Epidemiol 1992 May 1; 135(9): 1029–41PubMedGoogle Scholar
  34. 34.
    Blake AJ, Morgan K, Bendall MJ, et al. Falls by elderly people at home: prevalence and associated factors. Age Ageing 1988 Nov; 17(6): 365–72PubMedCrossRefGoogle Scholar
  35. 35.
    Campbell AJ, Spears GF. Fallers and non-fallers. Age Ageing 1990 Sep; 19(5): 345–6PubMedCrossRefGoogle Scholar
  36. 36.
    Graafmans WC, Ooms ME, Hofstee HM, et al. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 1996 Jun 1; 143(11): 1129–36PubMedCrossRefGoogle Scholar
  37. 37.
    Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis. II. Cardiac and analgesic drugs. J Am Geriatr Soc 1999 Jan; 47(1): 40–50PubMedGoogle Scholar
  38. 38.
    Luukinen H, Koski K, Laippala P, et al. Predictors for recurrent falls among the home-dwelling elderly. Scand J Prim Health Care 1995 Dec; 13(4): 294–9PubMedCrossRefGoogle Scholar
  39. 39.
    Prudham D, Evans JG. Factors associated with falls in the elderly: a community study. Age Ageing 1981 Aug; 10(3): 141–6PubMedCrossRefGoogle Scholar
  40. 40.
    Robbins AS, Rubenstein LZ, Josephson KR, et al. Predictors of falls among elderly people: results of two population-based studies. Arch Intern Med 1989 Jul; 149(7): 1628–33PubMedCrossRefGoogle Scholar
  41. 41.
    van Doom C, Gruber-Baldini AL, Zimmerman S, et al. Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 2003 Sep; 51(9): 1213–8CrossRefGoogle Scholar
  42. 42.
    Fuhrer R, Rouillon F. La version française de l’échelle CES-D (Center for Epidemiologic Studies-Depression Scale): description et traduction de l’échelle d’autoévaluation. Psychiatry Psychobiol 1989; 4: 163–6Google Scholar
  43. 43.
    Barberger-Gateau P, Rainville C, Letenneur L, et al. A hierarchical model of domains of disablement in the elderly: a longitudinal approach. Disabil Rehabil 2000 May 10; 22(7): 308–17PubMedCrossRefGoogle Scholar
  44. 44.
    Hosmer DW, Lemeshow S. Applied logistic regression: textbook and solutions manual. 2nd ed. New York: John Wiley & Sons Inc., 1989Google Scholar
  45. 45.
    Benichou J, Gail MH. Estimates of absolute cause-specific risk in cohort studies. Biometrics 1990 Sep; 46(3): 813–26PubMedCrossRefGoogle Scholar
  46. 46.
    Bruzzi P, Green SB, Byar DP, et al. Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol 1985 Nov; 122(5): 904–14PubMedGoogle Scholar
  47. 47.
    National Cancer Institute. Interactive risk attributable program (IRAP v2.2) [online]. Available from URL: http://dceg.cancer.gov/tools/analysis/irap/ [Accessed 2007 Nov 14]
  48. 48.
    Brutel C, Omalek L. Projections demographiques pour la France, ses regions et ses departements (horizon 2030–2050) [online]. Available from URL: http://www.insee.fr/fr/ffc/docs_ffc/irsoc016.pdf [Accessed 2007 Nov 14]
  49. 49.
    Lord SR, Ward JA, Williams P, et al. Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 1994 Oct; 42(10): 1110–7PubMedGoogle Scholar
  50. 50.
    Bloem BR, Grimbergen YA, Cramer M, et al. Prospective assessment of falls in Parkinson’s disease. J Neurol 2001 Nov; 248(11): 950–8PubMedCrossRefGoogle Scholar
  51. 51.
    Montero-Odasso M, Schapira M, Duque G, et al. Gait disorders are associated with non-cardiovascular falls in elderly people: a preliminary study. BMC Geriatr 2005; 5: 15PubMedCrossRefGoogle Scholar
  52. 52.
    Brassington GS, King AC, Bliwise DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years. J Am Geriatr Soc 2000 Oct; 48(10): 1234–40PubMedGoogle Scholar
  53. 53.
    Latimer Hill E, Cumming RG, Lewis R, et al. Sleep disturbances and falls in older people. J Gerontol A Biol Sci Med Sci 2007 Jan; 62(1): 62–6PubMedCrossRefGoogle Scholar
  54. 54.
    Gray SL, Eggen AE, Blough D, et al. Benzodiazepine use in older adults enrolled in a health maintenance organization. Am J Geriatr Psychiatry 2003 Sep–Oct; 11(5): 568–76PubMedGoogle Scholar
  55. 55.
    Jorm AF, Grayson D, Creasey H, et al. Long-term benzodiazepine use by elderly people living in the community. Aust N Z J Public Health 2000 Feb; 24(1): 7–10PubMedCrossRefGoogle Scholar
  56. 56.
    Valenstein M, Taylor KK, Austin K, et al. Benzodiazepine use among depressed patients treated in mental health settings. Am J Psychiatry 2004 Apr; 161(4): 654–61PubMedCrossRefGoogle Scholar
  57. 57.
    Zarifian E. Prescription of psychotropic drugs; use, misuse and abuse. Bull Acad Natl Med 1998; 182(7): 1439–46; discussion 46–7PubMedGoogle Scholar
  58. 58.
    French DD, Chirikos TN, Spehar A, et al. Effect of concomitant use of benzodiazepines and other drugs on the risk of injury in a veterans population. Drug Saf 2005; 28(12): 1141–50PubMedCrossRefGoogle Scholar
  59. 59.
    Gray SL, Penninx BW, Blough DK, et al. Benzodiazepine use and physical performance in community-dwelling older women. J Am Geriatr Soc 2003 Nov; 51(11): 1563–70PubMedCrossRefGoogle Scholar
  60. 60.
    Ankri J. Dependance du sujet age: quels chiffres? Rev Prat 2001; 15: 1623–6Google Scholar
  61. 61.
    Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, et al. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 1999 May 8; 353(9164): 1547–57PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Antoine Pariente
    • 1
    • 2
    • 3
  • Jean-Francois Dartigues
    • 3
    • 4
    • 5
  • Jacques Benichou
    • 6
    • 7
  • Luc Letenneur
    • 3
    • 4
    • 5
  • Nicholas Moore
    • 1
    • 2
    • 3
  • Annie Fourrier-Réglat
    • 1
    • 2
    • 3
  1. 1.Institut National de la Santé et la Recherche Médicale (INSERM)BordeauxFrance
  2. 2.Department of PharmacologyUniversité Victor SegalenBordeauxFrance
  3. 3.Centre Hospitalier et Universitaire (CHU) de BordeauxBordeauxFrance
  4. 4.Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED)INSERM, U593BordeauxFrance
  5. 5.Université Victor SegalenBordeauxFrance
  6. 6.INSERM U657RouenFrance
  7. 7.CHU de RouenRouenFrance

Personalised recommendations