Fall Risk, Healthcare Resource Use, and Costs Among Adult Patients in the United States Treated for Insomnia with Zolpidem, Trazodone, or Benzodiazepines: A Retrospective Cohort Study

Amari, Diana T.; Juday, Timothy; Frech, Feride; Wang, Weiying; Gor, Deval; Atkins, Norman; Wickwire, Emerson M.

doi:10.1007/s12325-022-02041-4

Cited by 8 publications

(3 citation statements)

References 51 publications

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“…Patients with dizziness and multiple comorbidities may require additional fall prevention strategies, including but not limited to low-intensity exercise, step training, home safety modifications, and support for caregivers . Medications taken for dizziness, particularly sedatives and vestibular suppressants, may also be associated with an increase in fall risk and their potential interaction with PT should be assessed in future work. Consistent with prior studies, we observed that the risk of falls resulting in a medical encounter after presentation for dizziness was lowest for racial and ethnic minority populations .…”

Section: Discussionmentioning

confidence: 99%

Use of Physical Therapy and Subsequent Falls Among Patients With Dizziness in the US

Marmor,

Karaca-Mandic,

Adams

2023

JAMA Otolaryngol Head Neck Surg

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ImportanceAmong adults who present for clinical evaluation of dizziness, there is a critical need to identify interventions, such as physical therapy (PT), to mitigate the risk of falls over time.ObjectiveThe primary objective was to examine the association between receipt of PT and falls requiring medical care within 12 months of presentation for dizziness. Secondary objectives included identification of factors associated with falls requiring medical care and factors associated with receipt of PT after presentation for dizziness.Design, Setting, and ParticipantsThis cross-sectional study examined US commercial insurance and Medicare Advantage claims from January 1, 2006, through December 31, 2015. In all, 805 454 patients 18 years or older with a new diagnosis of symptomatic dizziness or vestibular disorders were identified. Data were analyzed from October 1, 2021, to February 1, 2023.Main Outcomes and MeasuresReceipt of PT services and the incidence of falls requiring medical care were measured. The association between receipt of PT and falls that occurred 12 months after presentation for dizziness was estimated after accounting for presentation setting (outpatient clinic or emergency department), Charlson Comorbidity Index (CCI; with higher scores indicating greater morbidity), diagnosis code, and sociodemographic characteristics.ResultsA total of 805 454 patients presented for dizziness from 2006 through 2015 (median [range] age, 52 [18-87] years; 502 055 females [62%]). Of these patients, 45 771 (6%) received PT within 3 months of presentation for dizziness and 60 060 (7%) experienced a fall resulting in a medical encounter within 12 months after presentation for dizziness. In adjusted models, patients least likely to receive PT were female (adjusted odds ratio [AOR], 0.80; 95% CI, 0.78-0.81), those aged 50 to 59 years (AOR, 0.67 [95% CI, 0.65-0.70] compared with patients aged 18-39 years), and those with more comorbidities (AOR, 0.71 [95% CI, 0.70-0.73] for CCI ≥ 2 vs 0). Receipt of PT services within 3 months of presentation for dizziness was associated with a reduced risk of falls over the subsequent 12 months, with the greatest risk reduction found within 3 months after PT (AOR, 0.14 [95% CI, 0.14-0.15] at 3-12 months vs 0.18 [95% CI, 0.18-0.19] at 6-12 months and 0.23 [95% CI, 0.23-0.24] at 9-12 months).Conclusions and RelevanceResults of this cohort study suggest that receipt of PT after presentation for dizziness was associated with a reduction in fall risk during the subsequent 12 months; thus, timely PT referral for dizziness may be beneficial for these patients. Future research, ideally with a clinical trial design, is needed to explore the independent impact of PT on subsequent falls for adults with dizziness.

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Section: Discussionmentioning

confidence: 99%

Use of Physical Therapy and Subsequent Falls Among Patients With Dizziness in the US

Marmor,

Karaca-Mandic,

Adams

2023

JAMA Otolaryngol Head Neck Surg

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“…The review also noted that clinical trials of trazodone primarily as a treatment for depression have established the potential for side effects with this medication. The most common side effects are drowsiness, dry mouth, blurred vision, headaches, and falls [22]. Less common side-effects include priapism, a persistent painful penile or clitoral erection; the penile erection can lead to impotence in men [23][24][25][26][27][28] It is important to note that the view that the clinical evidence does not support trazodone as a treatment for first-line treatment for insomnia was the majority view of our sleep expert appraisal panel, but it was not the universal view.…”

Section: Discussionmentioning

confidence: 99%

Should Trazodone Be First-Line Therapy for Insomnia? A Clinical Suitability Appraisal

Pelayo

Bertisch

Morin

et al. 2023

JCM

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Trazodone is one of the most commonly used prescription medications for insomnia; however, some recent clinical guidelines do not recommend its use for treating insomnia. This clinical appraisal critically reviews the scientific literature on trazodone as a first-line treatment for insomnia, with the focus statement “Trazodone should never be used as a first-line medication for insomnia.” In addition, field surveys were sent to practicing physicians, psychiatrists, and sleep specialists to assess general support for this statement. Subsequently, a meeting with a seven-member panel of key opinion leaders was held to discuss published evidence in support and against the statement. This paper reports on the evidence review, the panel discussion, and the panel’s and healthcare professionals’ ratings of the statement’s acceptability. While the majority of field survey responders disagreed with the statement, the majority of panel members agreed with the statement based on the limited published evidence supporting trazodone as a first-line agent as they understood the term “first-line agent”.

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“…Given the low variability in CCI scores in our sample, we categorized CCI scores into those with low comorbidity (CCI = 0–2) and elevated comorbidity (CCI = 3 or more). Mental health diagnoses (Stewart et al, 2019) and physical conditions (Amari et al, 2022; Glasheen et al, 2019; Kalilani et al, 2019; Kasman et al, 2020) were both identified using previously published lists of diagnosis codes from the International Classification of Diseases–Clinical Modification (9th and 10th editions as appropriate).…”

Section: Methodsmentioning

confidence: 99%

Demographics and clinical characteristics of patients of prescribing psychologists, psychiatrists, and primary care physicians.

Hughes,

Niznik,

McGrath

et al. 2024

American Psychologist

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Fall Risk, Healthcare Resource Use, and Costs Among Adult Patients in the United States Treated for Insomnia with Zolpidem, Trazodone, or Benzodiazepines: A Retrospective Cohort Study

Cited by 8 publications

References 51 publications

Use of Physical Therapy and Subsequent Falls Among Patients With Dizziness in the US

Use of Physical Therapy and Subsequent Falls Among Patients With Dizziness in the US

Should Trazodone Be First-Line Therapy for Insomnia? A Clinical Suitability Appraisal

Demographics and clinical characteristics of patients of prescribing psychologists, psychiatrists, and primary care physicians.

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