liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Use of non-benzodiazepine hypnotics is associated with falls in nursing home residents: a longitudinal cohort study
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Department of Geriatrics, County Hospital Ryhov, Jönköping, Sweden.ORCID iD: 0000-0002-2491-4232
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ödeshög.
Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Show others and affiliations
2019 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 31, no 8, p. 1078-1095Article in journal (Refereed) Published
Abstract [en]

Background

Falls and related injuries are common among older people, and several drug classes are considered to increase fall risk.

Aims

This study aimed to investigate the association between the use of certain drug classes and falls in older nursing home residents in Sweden, and relate these to different age groups.

Methods

Information on falls that occurred in the previous year and regular use of possible fall risk drugs including non-benzodiazepine hypnotics (zopiclone and zolpidem) was collected from 331 nursing home residents during 2008–2011. Over the following 6 months, the occurrence of serious falls, requiring a physician visit or hospital care, was registered. Association between serious falls and drug use was compared between an older (≥ 85 years) and a younger group.

Results

An increased fall risk (Downton Fall Risk Index ≥ 3) was found in 93% of the study subjects (aged 65–101 years). Baseline data indicated an association between falls that occurred in the previous year and regular use of non-benzodiazepine hypnotics (p = 0.005), but not with the other studied drug classes. During the following 6 months, an association between use of non-benzodiazepine hypnotics and serious falls in the older group (p = 0.017, odds ratio 4.311) was found. No association was found between the other studied drug classes and serious falls.

Discussion

These results indicate an association between falls and the use of non-benzodiazepine hypnotics, compounds that previously have been considered generally well-tolerated in older people.

Conclusions

Caution is advocated when using non-benzodiazepine hypnotics regularly in older people living in nursing homes.

Place, publisher, year, edition, pages
Springer, 2019. Vol. 31, no 8, p. 1078-1095
Keywords [en]
Accidental falls, Frail elderly, Nursing homes, Hypnotics and sedatives, Adverse effects, Longitudinal study
National Category
Rheumatology and Autoimmunity Geriatrics Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:liu:diva-156240DOI: 10.1007/s40520-018-1056-0ISI: 000477664800007PubMedID: 30341643Scopus ID: 2-s2.0-85055751099OAI: oai:DiVA.org:liu-156240DiVA, id: diva2:1303263
Note

Funding agencies:  Medical Research Council of Southeast Sweden (FORSS); Futurum-Academy of Health and Care, Region Jonkoping County

Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-08-12Bibliographically approved
In thesis
1. Geriatric Aspects of Frail Nursing Home Residents: A Swedish cohort study
Open this publication in new window or tab >>Geriatric Aspects of Frail Nursing Home Residents: A Swedish cohort study
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The number and proportion of older people are increasing in Sweden as well as throughout the western world. Older people with increasing assistance needs that can no longer be met in their own home need institutional long-term care in nursing homes. A successive reduction of nursing home beds in combination with a future demographic development with a rapidly increasing number of older people will lead to higher demands on future medical care in nursing homes. Consequently, increased knowledge about the medical needs of nursing home residents is of great value.

Objectives: This thesis explores some important geriatric aspects of frail nursing home residents. The specific aims was to characterise the population of nursing home residents, to explore the prevalence of anaemia, paying particular attention to risk factors and mortality, to investigate associations between falls and use of possible fall risk drug classes and to estimate the prevalence of diagnostic failure of cognitive impairment and to investigate whether diagnostic failure was associated with impaired medical care.

Methods: All data originate from SHADES (the Study of Health and Drugs in Elderly nursing home residents in Sweden), a prospective cohort study that included nursing home residents at 12 nursing homes situated in three municipalities in southern Sweden between 2008 and 2011. The subjects were followed every six months with data collection from medical records concerning medications, diagnoses, hospital referrals and mortality, examinations including blood sample analyses, assessments with validated rating scales for cognitive evaluation, depression, risk of pressure ulcers, malnutrition or falls, and the need for care was rated through a questionnaire.

Results: SHADES included a total of 428 subjects with a mean age of 85 years, of whom 71% were women. They demonstrated comorbidity with a mean of three registered medical diagnoses, and polypharmacy with a mean of seven regularly used drugs. More than half of the sample (60%) were at risk of malnutrition and one third were at risk of developing pressure ulcers. A set of single items from the performed risk assessments was found to be important in understanding frailty and need for care. One third of the women and half of the men had anaemia. For the men, anaemia was associated with significantly higher mortality. Haemoglobin decline was also associated with higher mortality. Almost everyone (93%) had an increased fall risk and 62% had fallen during the last year. There was an association between falls during the last year and regular use of non-benzodiazepine hypnotics. In the older age group there was also an association between these drugs and serious falls the next 6 months. Dementia was previously diagnosed in 42%. However, among subjects without a dementia diagnosis, 72% were cognitively impaired (Mini Mental State Examination <24). These subjects were significantly older, did not get anti-dementia treatment and had higher levels of brain natriuretic peptide compared to the diagnosed dementia group, possibly indicating heart failure. Their risks of malnutrition and pressure ulcers were similar to the dementia group.

Conclusions: Nursing home residents are generally frail. Anaemia is associated with higher mortality among men. The fall risk is generally high and use of non-benzodiazepine hypnotics is associated with a higher occurrence of falls. Cognitive impairment is undiagnosed in half of the cases and may indicate underlying heart failure. Consequently, regular medical follow-ups in this population are proposed to include blood count, drug review, and cognitive evaluation. In the case of cognitive impairment, exclusion of underlying disease such as heart failure should be considered.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1674
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-155641 (URN)10.3384/diss.diva-155641 (DOI)978-91-7685-101-2 (ISBN)
Public defence
2019-05-03, Originalet, Qulturum, Hus B4, Länssjukhuset Ryhov, Jönköping, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2019-03-25 Created: 2019-03-21 Last updated: 2019-07-25Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMedScopus

Authority records BETA

Westerlind, BjörnÖstgren, Carl JohanMölstad, SigvardHägg, Staffan

Search in DiVA

By author/editor
Westerlind, BjörnÖstgren, Carl JohanMölstad, SigvardHägg, Staffan
By organisation
Division of Neuro and Inflammation ScienceFaculty of Medicine and Health SciencesDivision of Community MedicinePrimary Health Care Center ÖdeshögDivision of Drug ResearchDepartment of Clinical Pharmacology
In the same journal
Aging Clinical and Experimental Research
Rheumatology and AutoimmunityGeriatricsPharmacology and Toxicology

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 77 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf