Association between nocturnal falls and hypnotic drug use in older patients at acute care hospitals

Abstract

Abstract Purpose: Although hypnotic drug use is a known risk factor for falls, few reports have analyzed fall risk associated with individual hypnotic drugs after adjusting for confounding factors. Therefore, it remains unclear whether clinically prescribed benzodiazepine receptor agonist, melatonin receptor agonist, and/or orexin receptor antagonist use is safe in older patients. Here, we aim to assess the influence of various hypnotic drugs on fall risk in older patients admitted to acute care hospitals. Methods: We investigated the relationship between nocturnal falls and sleeping pill use among 8,044 hospitalized patients aged > 65 years. We used a propensity score matching method to homogenize characteristics of patients with and without nocturnal falls (n = 145 patients in each group) using 24 extracted factors (excluding hypnotic drugs) as covariates. Results: Our analysis of fall risk for each hypnotic drug revealed that benzodiazepine receptor agonists were the only drugs significantly associated with falls, suggesting that use of the drugs is a risk factor for falls in older adults (p = 0.003). In addition, a multivariate analysis of 24 selected factors, excluding hypnotic drugs, revealed that patients with advanced recurrent malignancies were at greatest risk of experiencing falls (OR: 2.62; 95% CI: 1.23–5.60; p = 0.013). Conclusion: Benzodiazepine receptor agonists should be avoided in older hospitalized patients since they increase fall risk, with melatonin and orexin receptor antagonists used instead. Particularly, fall risk associated with hypnotic drugs should be considered in patients with advanced recurrent malignancies.