Benzodiazepines and Injurious Falls in Community Dwelling Elders
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ORIGINAL RESEARCH ARTICLE
© 2008 Adis Data Information BV. All rights reserved.
Benzodiazepines and Injurious Falls in Community Dwelling Elders Antoine Pariente,1,2,3 Jean-Francois Dartigues,3,4,5 Jacques Benichou,6,7 Luc Letenneur,3,4,5 Nicholas Moore1,2,3 and Annie Fourrier-R´eglat1,2,3 1 2 3 4
Institut National de la Sant´e et la Recherche M´edicale (INSERM), U657, Bordeaux, France Department of Pharmacology, Universit´e Victor Segalen, Bordeaux, France Centre Hospitalier et Universitaire (CHU) de Bordeaux, Bordeaux, France INSERM, U593, Institut de Sant´e Publique, d’Epid´emiologie et de D´eveloppement (ISPED), Bordeaux, France 5 Universit´e Victor Segalen, Bordeaux, France 6 INSERM, U657, Rouen, France 7 CHU de Rouen, Rouen, France
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 Ag´ees 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 2 years in almost 80% of benzodiazepine-treated elderly patients.[7,8] Benzodiazepines offer only symptomatic relief for sleep disorders and cause dependency. Once started, there is little incentive to stop treatment with these drugs. In the absence of curative treatment, the underlying disease will usually persist. Furthermore, there is no penalty for not stopping benzodiazepine treatment, despite official recommendations. Since, in addition, benzodiazepines cause withdrawal symptoms, it is not surprising that a large number of elderly patients continue to use them long term. Benzodiazepines may be injurious to the health of elderly patients.[5,9] Many studies have evaluated the association between benzodiazepine use and falls, injurious falls, falls requiring medical attention and hip fractures. Some found a significantly increased risk for benzodiazepine users[10-19] whereas others found no significant association,[20-25] leading to inconsistencies in the literature. Falls are a frequent and major cause of morbidity in the elderly © 2008 Adis Data Information BV. All rights reserved.
but their numerous definitions do not always allow a clear perception of their consequence
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