Hypnotics and injuries among older adults with Parkinson’s disease: a nested case–control design

Abstract

Background Patients with Parkinson’s disease often experience sleep disorders. Hypnotics increase the risk of adverse events, such as injuries due to falls. In this study, we evaluated the association between hypnotics and injuries among older adults with Parkinson’s disease. Methods The study used a nested case–control design. The participants were 5009 patients with Parkinson’s disease aged ≥ 75 years based on claims data between April 2016 and March 2019 without prescription hypnotics 1 year before the study started. Hypnotics prescribed as oral medications included benzodiazepines, non-benzodiazepines, orexin receptor antagonists, and melatonin receptor agonists. The incidences of outcomes, including injuries, fractures, and femoral fractures, were determined. Each case had four matched controls. Conditional logistic regression analyses were performed to calculate the odds ratios and 95% confidence intervals for the number of hypnotics taken per day for each type of hypnotic. Results The proportion of participants taking at least one type of hypnotic was 18.6%, with benzodiazepines being the most common. The incidence of injuries, fractures, and femoral fractures was 66.7%, 37.8%, and 10.2%, respectively. Benzodiazepines significantly increased the risk of injuries (odds ratio: 1.12; 95% confidence interval: 1.03–1.22), and melatonin receptor agonists significantly increased the risk of femoral fractures (odds ratio: 2.84; 95% confidence interval: 1.19–6.77). Conclusions Benzodiazepines and non-benzodiazepines, which are not recommended according to current guidelines, were the most prevalent among older adults with Parkinson’s disease. Benzodiazepines significantly increased the risk of injuries, and melatonin receptor agonists significantly increased the risk of femoral fractures.

The role of nurses for patients with Parkinson’s disease at home: a scoping review

“…However, in patients with PD, only the dopamine agonist rotigotine has been shown to be effective; evidence for the efficacy of other drugs is insufficient [44]. Among older patients with PD, 18.6% were prescribed hypnotics, with benzodiazepines being reported to increase the risk of injury significantly, and melatonin receptor agonists reportedly significantly increasing the risk of femoral fractures [46]. Therefore, it is important to understand the treatments for non-motor symptoms and to provide nursing care while considering their side effects.…”

Benzodiazepines and mortality: Consideration of potential confounders

“…For example, benzodiazepines are widely used in common chronic neurodegenerative conditions such as Alzheimer's and Parkinson's disease. 5,6 This may be prescribed not primarily for anxiety or insomnia. In addition, benzodiazepine use has been associated with increased risk of dementia.…”