Hospitalized patients on orexin receptor antagonists have a lower risk of falls
Abstract
Falls and fall-related injuries remain a major safety concern in many hospitals and nursing homes. Although many studies have examined the relationship between accidents and sedating medications, further analysis is needed of the association between falls and individual hypnotics. The aim of this study was to clarify the association between hypnotics and the risk of falls in hospital. The impact of hypnotics on fall events was retrospectively evaluated in patients aged 20 years or older who were admitted to Gunma University Hospital between January 2013 and March 2022. Logistic regression analysis was performed with age, sex, and drug prescription status as the independent variables and fall events as the dependent variable. Of the 54,019 patients included in the study, 1,460 experienced a fall during hospitalization (incidence, 2.7%). The hypnotics prescribed included orexin receptor antagonists, melatonin receptor agonists, and benzodiazepine receptor agonists. Logistic regression analysis showed that age (odds ratio [OR] 1.04), male sex (OR 1.14), estazolam (OR 2.99), flunitrazepam (OR 2.34), brotizolam (OR 1.65), diazepam (OR 3.34), lorazepam (OR 2.93), alprazolam (OR 1.91), ethyl loflazepate (OR 2.81), zolpidem (OR 1.40), eszopiclone (OR 1.87), clonazepam (OR 1.94), and ramelteon (OR 2.15) independently contributed to falls. Short-acting benzodiazepine receptor agonists tended to have smaller ORs for fall risk. Orexin receptor antagonists were not associated with falls. Therefore, orexin receptor antagonists and short-acting benzodiazepine receptor agonists are likely safer than intermediate-acting and long-acting benzodiazepines.
Keywords: fall risk, hypnotics, acute care hospitals
References
Itani O, Kaneita Y, Munezawa T, Mishima K, Jike M, Nakagome S, et al.
Nationwide epidemiological study of insomnia in Japan. Sleep Med
;25:130–8.
Nielsen S. Benzodiazepines. Curr Top Behav Neurosci 2017;34:141–59.
Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, et al. Meta-
analysis of the impact of 9 medication classes on falls in elderly persons. Arch
Intern Med 2009;169:1952–60.
Buth S, Holzbach R, Martens M-S, Neumann-Runde E, Meiners O, Verthein U.
Problematic Medication With Benzodiazepines, “Z-drugs”, and Opioid Analgesics.
Dtsch Arztebl Int 2019;116:607–14.
Valencia Morales DJ, Laporta ML, Johnson RL, Schroeder DR, Sprung J,
Weingarten TN. A Case-Control Study of Accidental Falls During Surgical
Hospitalizations. Am Surg 2023;89:61–8.
Seppala LJ, Wermelink AMAT, de Vries M, Ploegmakers KJ, van de Glind EMM,
Daams JG, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-
Analysis: II. Psychotropics. J Am Med Dir Assoc 2018;19:371.e11-371.e17.
Obayashi K, Araki T, Nakamura K, Kurabayashi M, Nojima Y, Hara K, et al. Risk
of falling and hypnotic drugs: retrospective study of inpatients. Drugs R D
;13:159–64.
Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries
Among Adults Aged ≥65 Years - United States, 2012-2018. MMWR Morb Mortal
Wkly Rep 2020;69:875–81.
Court-Brown CM, Clement ND, Duckworth AD, Biant LC, McQueen MM. The
changing epidemiology of fall-related fractures in adults. Injury 2017;48:819–24.
LeLaurin JH, Shorr RI. Preventing Falls in Hospitalized Patients: State of the
Science. Clin Geriatr Med 2019;35:273–83.
Gammel LB, Leonard M, Wheeler H, Linh H, Burns B Jr. Controlled Substance
Use and Clinical Outcomes of Elderly Patients After a Fall. Cureus
;14:e22356.
Hashida R, Matsuse H, Yokoyama S, Kawano S, Higashi E, Tajma H, et al. Balance
dysfunction the most significant cause of in-hospital falls in patients taking
hypnotic drugs: A retrospective study. PLoS One 2022;17:e0272832.
Oren G, Jolkovsky S, Tal S. Falls in oldest-old adults hospitalized in acute geriatric
ward. Eur Geriatr Med 2022;13:859–66.
Noh H-M, Song HJ, Park YS, Han J, Roh YK. Fall predictors beyond fall risk
assessment tool items for acute hospitalized older adults: a matched case-control
study. Sci Rep 2021;11:1503.
Bland H, Li X, Mangin E, Yee KL, Lines C, Herring WJ, et al. Effects of Bedtime
Dosing With Suvorexant and Zolpidem on Balance and Psychomotor Performance
in Healthy Elderly Participants During the Night and in the Morning. J Clin
Psychopharmacol 2021;41:414–20.
Murphy P, Kumar D, Zammit G, Rosenberg R, Moline M. Safety of lemborexant
versus placebo and zolpidem: effects on auditory awakening threshold, postural
stability, and cognitive performance in healthy older participants in the middle of
the night and upon morning awakening. J Clin Sleep Med 2020;16:765–73.
Zammit G, Wang-Weigand S, Rosenthal M, Peng X. Effect of ramelteon on middle-
of-the-night balance in older adults with chronic insomnia. J Clin Sleep Med
;5:34–40.
Ishibashi Y, Nishitani R, Shimura A, Takeuchi A, Touko M, Kato T, et al. Non-
GABA sleep medications, suvorexant as risk factors for falls: Case-control and
case-crossover study. PLoS One 2020;15:e0238723.
Torii H, Ando M, Tomita H, Kobaru T, Tanaka M, Fujimoto K, et al. Association of
Hypnotic Drug Use with Fall Incidents in Hospitalized Elderly Patients: A Case-
Crossover Study. Biol Pharm Bull 2020;43:925–31.
Sogawa R, Emoto A, Monji A, Miyamoto Y, Yukawa M, Murakawa-Hirachi T, et
al. Association of orexin receptor antagonists with falls during hospitalization. J
Clin Pharm Ther 2022;47:809–13.
Mj G. Falls in later life. Improving the Health of Older People A World View
:296–315.
Mj G. Falls in later life. Improving the Health of Older People A World View 1990:296–315.
Kobayashi K, Ando K, Nakashima H, Suzuki Y, Nagao Y, Imagama S. Relationship between use of sleep medication and accidental falls during hospitalization. Nagoya J Med Sci 2021;83:851–60.
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