Elsevier

Maturitas

Volume 101, July 2017, Pages 17-22
Maturitas

Review
Relationship between the use of benzodiazepines and falls in older adults: A systematic review

https://doi.org/10.1016/j.maturitas.2017.04.002Get rights and content

Highlights

  • An updated review is presented of the link between the use of benzodiazepines and falls in the elderly.

  • Benzodiazepines increase the risk of falling when used either as monotherapy or in combined therapies.

  • A high proportion of falls in older adults are related to the use of benzodiazepines.

Abstract

Falls in the elderly represent a major health problem. The etiology of falls is usually multifactorial. Special attention should be paid on benzodiazepines (BZDs) since they are widely used by older adults.

A literature search of the PUBMED and EMBASE databases from January 2007 to February 2017 was conducted using the MeSH terms “benzodiazepines”, “elderly” and “falls” or “accidental falls”. The systematic review was performed according to PRISMA criteria.

Of the 27 references selected for full reading from 235 found, 15 were eliminated and 12 papers were selected for systematic review.

Exposure to BZDs was associated with a higher risk of falls in older adults, which is consistent with the results reported in the literature and previous reviews and meta-analyses. BZDs increase the risk of falling when used either as monotherapy or in combined therapies. It is preferable to use short-acting BZDs, to avoid cumulative effects over time predisposing to falls.

A high proportion of falls in older adults are related to the use of BZDs. They should be prescribed to older patients in accordance with current clinical guidelines and reviewed over time. BZDs should be prescribed as a short-term therapy and progressively withdrawn. Short-acting BZDs should be the treatment of choice.

Introduction

Falls in the elderly represent a major health problem, frequently reduce the quality of life of patients, and may result in long hospitalization or even death [1]. They are the second leading cause of accidental injury worldwide. As many as 424,000 fatal falls occur each year, with the highest incidence rates in adults over 65 years of age. A total of 37.3 million visits related to falls are made to emergency departments annually, which has a high economic cost [2]. At least 30% of adults aged over 65 years experience a fall every year, peaking up to 50% in adults over 80 years of age. Furthermore, falls have long-term sequelae in more than half of older adults [3]. Due to its high prevalence and deleterious effects, falls are a primary health problem among the elderly, which requires especial attention [4].

The etiology of falls is usually multifactorial [5] and involves both the individual characteristics of the patient (sex, age, chronic illness, visual acuity, etc.), and environmental (architectural barriers, etc.). In addition, however, drug-related factors can also be responsible for falls in the elderly. In this regard, special attention should be paid to hypnotic sedatives and primarily to benzodiazepines (BZDs), since they are widely used in older adults [6], are the hypnotic sedatives of choice in most cases and are often found to have been inappropriately drugs [7]. Age-related changes in pharmacokinetics and pharmacodynamics are predisposing factors for falls in this population of patients [8]. In fact, older adults are more susceptible to the side-effects of BZDs and they have a greater risk of incident mobility disability, which in turn affects their activities of daily living [9].

In 2008, Woolcott et al. published a meta-analysis [10] concluding that the use of hypnotic sedatives is significantly related to falls in older adults. With the purpose of reducing the incidence of falls among the elderly, a variety of guidelines and recommendations on the reduction in the use of these drugs in this age group have been published [11].

We performed a systematic review of the scientific literature to collect updated data on the relationship between the use of BZDs and the risk of falls in older adults.

Section snippets

Methods

A literature search of the PUBMED and EMBASE databases from January 2007 to February 2017 was conducted using the MeSH and free terms as follows: ((“Benzodiazepines”[Mesh] OR “Psychotropic Drugs”[Mesh]) AND (“Aged”[Mesh] OR “elderly” OR “older”) AND (“Accidental Falls”[Mesh] or “fall”)). A systematic review was performed according to PRISMA criteria [12]. The inclusion criteria were: papers published in English or Spanish on prospective studies assessing the relationship between the use of BZDs

Results

The database searches returned 235 references, of which 208 were discarded after title and abstract screening. Of the 27 references selected for full reading, 15 were eliminated: 3 as they were duplicated in these references and 12 for not meeting the inclusion criteria. Thus, 12 papers were selected for systematic review (Table 1).

Landi et al. conducted an observational study [14] to assess the increased risk of falls among older adults associated with the use of psychotropic drugs. The study

Discussion

According to the studies included in our systematic review, exposure to BZDs is associated with a higher risk for falls in older adults, which is consistent with the results reported in previous reviews and meta-analyses [10]. This review updates the results of previous studies and suggests that clinical practice guidelines and recommendations on reducing the use of BZDs in older patients [26] and on paying special attention to the occurrence of falls [27] have been so far ineffective. Thus,

Contributors

Study concept and design: M.J.D.-G., M.M.-C. and A.G.-P.

Acquisition of literature sources and data extraction: M.J.D.-G. and M.M.-C.

Interpretation of data: M.J.D.-G., E.S.d.A., A.I.C., M.T.M.-C.

Preparation of manuscript: M.J.D.-G., A.B., R.S., M.M.-C., A.G.-P.

All authors saw and approved the final version of the manuscript.

Conflict of interest

The authors have no conflicts of interest to declare.

Funding

This work was supported by the Spanish Government (ISCIII), and was co-financed by the “Subdirección General de Evaluación y Fomento de la Investigación, Fondo Europeo de Desarrollo Social (FEDER)” (PI15/00789; PI12/02077; PI14/01900; EC10-220); other support was received from the Basque Foundation for Health Innovation and Research (BIOEF); Networking Center for Biomedical Research in Mental Health (CIBERSAM); Department of Education, Linguistic Policy and Culture of the Basque Country

Provenance and peer review

This article has undergone peer review.

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