Benzodiazepine Use and Falls in Older Adults: Is It Worth the Risk?

McDonald, Elissa M; Caslangen, Joan

doi:10.3928/19404921-20190813-01

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…In our study, the risk was the highest when people aged 80–84 years were prescribed long-acting BZDs and when people aged ≥85 years were prescribed TCAs, indicating that the risk increased with age. Corroborating our results, previous studies showed that age is one of the greatest risk factors for fall fractures in older adults [ 23 , 24 , 25 ]. Therefore, for older adults (≥85 years of age), high-risk medication should be avoided or used cautiously, if at all possible, based on the adverse effects.…”

Section: Discussionsupporting

confidence: 90%

Risk of Falls Associated with Long-Acting Benzodiazepines or Tricyclic Antidepressants Use in Community-Dwelling Older Adults: A Nationwide Population-Based Case–Crossover Study

Seo

Park

et al. 2022

IJERPH

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Background: Falls are common in older adults and increase in recent years. This study aimed to examine the risk of falls associated with long-acting benzodiazepines (BZDs) or tricyclic antidepressants (TCAs) use in community-dwelling older adults. Methods: A nationwide population-based case–crossover design was used. We screened information on 6,370,275 fall or fall fracture cases among community-dwelling elderly patients from the database of the national health insurance data warehouse in South Korea. We extracted the data of elderly patients who visited the hospital for a fall and were diagnosed with the first fall or fall fracture after prescription of long-acting BZDs (n = 1805) or TCAs (n = 554). The study used conditional logistic regression analysis to analyze the associations and stratified analysis by gender and age group to control for their confounding effects. Results: Risk of falls or fall fractures increased by more than two times after taking long-acting BZDs (odds ratio [OR] = 2.16; 95% confidence interval [CI] = 1.85–2.52) or TCAs (OR = 2.13; 95% CI = 1.62–2.83). The longer the prescription period of both, the higher the risk of falls or fall fractures was (≥49 days for long-acting BZDs vs. ≥ 56 days for TCAs). Conclusions: Long-acting BZDs or TCAs should be avoided or prescribed for a shorter duration based on these adverse effects. Health care providers should focus on fall prevention practices in older adults who take such drugs.

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Section: Discussionsupporting

confidence: 90%

Risk of Falls Associated with Long-Acting Benzodiazepines or Tricyclic Antidepressants Use in Community-Dwelling Older Adults: A Nationwide Population-Based Case–Crossover Study

Seo

Park

et al. 2022

IJERPH

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“…Our study found a prevalence of 40 % of falls. Falls associated with the use of benzodiazepines have been reported by several authors; Coutinho and Dutra concluded that the risk of a benzodiazepine user suffering falls is 109 % higher than those who do not use this class of medication [37][38][39][40]. A study conducted in the Netherlands found that approximately 60 % of patients using medication suffered one or more falls, and exposure to psychotropic drugs increases the chance of an individual falling by 96 % [41].…”

Section: Discussionmentioning

confidence: 99%

Deprescribing clonazepam in primary care older patients: a feasibility study

Silva

Pinto

Queiroz³

et al. 2022

Int J Clin Pharm

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Background: Inappropriate use of clonazepam by the elderly patients is associated with cognitive impairment, delirium and falls. Strategies to optimize its use are important to increase patient safety.Objective: To evaluate the feasibility of a clonazepam deprescription protocol in the elderly.Methods: This is a quasi-experimental study. Elderly people with chronic use of clonazepam and attended in primary care units in two Brazilian municipalities were selected. A deprescription protocol was used, which included ve fortnightly meetings between the older adults and the research team, to reduce the dose by 25 %. Patients received instructions on sleep hygiene behaviors and the advantages of clonazepam deprescription; family physicians followed a owchart for gradual dose reduction. In the 1 st and 5 th meetings, there were medical appointments for anamnesis and discharge. The monitoring of patients and the application of tests were carried out by the research team.Results: Of the 35 elderly people included in the study, 27 reached the end; 81.5 % achieved deprescription: 22.2 % stopped completely and 59.3 % decreased the dose. At the last meeting, 20 % of elderly patients reported an increase in blood pressure.Conclusions: The high rate of deprescription and the little relevance of clonazepam withdrawal reactions, showed that the use of the protocol was effective. However, the increase in blood pressure and the worsening of sleep quality in the last meeting show the need for adjustment in the last stage of the deprescription process.

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“…Furthermore, as people age, the sleep-wake pattern is significantly altered by variables such as physical disease 9 ) , decreased melatonin release, and failure of sleep-related brain circuits. Sleep disruptions are directly associated with various health disorders 10 ) .…”

Section: Introductionmentioning

confidence: 99%

“…Recently, it was discovered that the inability of patients with dementia to explain the pain and subjective symptoms they experience daily to healthcare providers worsens their polypharmacy and use of possibly unsuitable drugs 20 ) . To address this issue, nurses assume the lead in managing the daily lives of patients with dementia and provide psychological care 9 ) . Although nurses’ practices resemble those of physicians and pharmacists in certain respects, they are responsible for multidisciplinary management, education, and continuous medication monitoring following prescriptions.…”

Section: Introductionmentioning

confidence: 99%

Applicability of the Self-Evaluation Scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills to general nurses

Iwamoto,

Fujino,

Furuno

et al. 2024

J Rural Med

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Objective: Many patients with dementia experience sleep-related problems. However, there is a lack of clarity regarding nursing practices that can address these issues. Thus, we developed a self-assessment scale for nursing practices to improve sleep quality among patients with dementia taking sleep medication and confirmed its validity and reliability. This study aimed to test the validity and reliability of this scale for adaptability to general nurses and test its applicability. Participants and Methods:The survey included basic attributes and questionnaire items related to nursing practices to improve sleep quality in patients with dementia taking sleeping pills. Data from 477 participants with no missing values in the survey items were used in the analysis. The self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills was based on a three-factor model, and confirmatory factor analysis was performed using structural equation modeling.Results: Goodness-of-fit indices were satisfactory, supporting the construct validity of the scale. Cronbach's α coefficients for the total score and the three factors of the self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills exceeded 0.7. Conclusion:The development of this scale can improve the quality of nursing practice for patients with dementia who take sleeping pills. Moreover, it can serve as evidence for general nurses to participate in drug treatment and can be considered as basic research for appropriate drug treatment in nursing practice.

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Benzodiazepine Use and Falls in Older Adults: Is It Worth the Risk?

Cited by 7 publications

References 19 publications

Risk of Falls Associated with Long-Acting Benzodiazepines or Tricyclic Antidepressants Use in Community-Dwelling Older Adults: A Nationwide Population-Based Case–Crossover Study

Risk of Falls Associated with Long-Acting Benzodiazepines or Tricyclic Antidepressants Use in Community-Dwelling Older Adults: A Nationwide Population-Based Case–Crossover Study

Deprescribing clonazepam in primary care older patients: a feasibility study

Applicability of the Self-Evaluation Scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills to general nurses

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