ReviewRelationship between the use of benzodiazepines and falls in older adults: A systematic review
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.
References (50)
- et al.
Health care and socioeconomic impact of falls in the elderly
Am. J. Surg.
(2012) - et al.
Association between benzodiazepines and recurrent falls: a cross-sectional elderly population-based study
J. Nutr. Health Aging
(2011) - et al.
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
J. Clin. Epidemiol.
(2009) - et al.
What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population
Sleep Med.
(2012) - et al.
Psychotropic medications, including short acting benzodiazepines, strongly increase the frequency of falls in elderly
Maturitas
(2013) The problems with the use of benzodiazepines in elderly patients
L’Encéphale
(2010)- et al.
The association between dementia and long-term use of benzodiazepine in the elderly: nested case-control study using claims data
Am. J. Geriatr. Psychiatry
(2009) - et al.
Benzodiazepine use and cognitive decline in elderly with normal cognition
Alzheimer Dis. Assoc. Disord.
(2016) - et al.
Effect of benzodiazepine discontinuation on dementia risk
Am. J. Geriatr. Psychiatry
(2011) - et al.
Benzodiazepine use in older adults: dangers, management, and alternative therapies
Mayo Clin. Proc.
(2016)