Sedatives increase risk of falls in elderly

Journal of Clinical Nursing has an article about a recent study linking the use of sleeping pills containing benzodiazepines to increase falls in nursing homes.
Older patients taking benzodiazepines were 2.9 times more likely to fall   Obviously, patients who fall suffer severe injuries.   Some older patients have impaired cognitive function or limited functional ability and physical strength stemming from chronic physical ailments, increasing their risk of a fall, often when walking or being moved.

In addition, older patients are take multiple medications, whose side effects increase the patients’ chances of a fall.  Physical restraints may be used to decrease the possibility of falling and being injured.

“Even if no physical injury occurs, fall victims may develop a fear of falling again and thus reduce their activities as a result,” the authors wrote. “This can lead to unnecessary dependency, loss of function, decreased socialization, and a poor quality of life.”

The researchers found that use of sleeping pills containing benzodiazepines was significantly associated with fractures supporting the findings of most previous studies.

Patients using wheelchairs and bed rails were less likely to fall, but neither of the associations reached statistical significance. Nevertheless, “the use of these might be regarded as protective or preventative strategies,” the researchers said.

Bed rails can cause injuries if patients climb over them, and physically restraining an already agitated individual can increase fear and worsen behavior, they said.   “In addition, restraints can lead to serious complications, including circulatory obstruction, skin tears, incontinence, fractures, and dislocations,” they wrote. “These restraints should be used with care and consideration.”

The Study recognized that restraints cannot completely eliminate falls in nursing homes and that they may not be appropriate in every situation, but concluded that “our results support the hypothesis that they might be protective when used selectively together with fewer sedatives, especially benzodiazepines.”

Primary source: Journal of Clinical Nursing
Source reference:
Fonad E, et al “Falls and fall risk among nursing home residents”J Clin Nurs 2008; 17: 126-134.