The elimination half-life of benzodiazepines and fall risk: two prospective observational studies

• Published in: Age and ageing Vol. 42; no. 6; pp. 764 - 770
• Main Authors: de Vries, Oscar J, Peeters, Geeske, Elders, Petra, Sonnenberg, Caroline, Muller, Majon, Deeg, Dorly J H, Lips, Paul
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-11-2013; Oxford Publishing Limited (England)
• Subjects: Accidental falls; Accidental Falls - prevention & control; Accidental Falls - statistics & numerical data; Age Factors; Aged; Aged patients; Aged, 80 and over; Aging; Benzodiazepines; Benzodiazepines - adverse effects; Benzodiazepines - pharmacokinetics; Care and treatment; Complications and side effects; Demographic aspects; Elderly patients; Falls; Falls (Accidents); Female; Half-Life; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - pharmacokinetics; Longitudinal Studies; Male; Middle Aged; Netherlands; Older people; Patient Selection; Prevention; Prospective Studies; Psychotropic drugs; Risk Assessment; Risk Factors; Netherlands; Netherlands, Noord-Holland, Amsterdam; accidental falls; aged; adverse drug events; older people; benzodiazepines; sedatives
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/aft089

the STOPP criteria advise against the use of long-acting benzodiazepines (LBs).
to study whether LBs are associated with a higher fall risk than short-acting benzodiazepines (SBs) (elimination half-life ≤ 10 h).
we used base-line data and prospective fall follow-up from the Longitudinal Aging Study Amsterdam, a longitudinal cohort study including 1,509 community-dwelling older persons (Study 1) and from a separate fall prevention study with 564 older persons after a fall (Study 2). Time to the first fall after inclusion and number of falls in the first year after inclusion were the primary endpoints.
both in Study 1 and Study 2 the use of SBs was associated with time to the first fall, hazard ratio (HR) 1.62 (95% CI: 1.03-2.56) and HR 1.64 (95% CI: 1.19-2.26),respectively. LBs were not significantly associated with time to first fall, HR 1.40 (0.85-2.31) and HR 1.08 (0.72-1.62). In both studies, the use of SBs was also associated with number of falls, odds ratio (OR) 1.28 (95% CI: 1.01-1.61) and OR 1.37 (95% CI: 1.10-1.70). LBs were not significantly associated with number of falls, OR 1.23 (0.96-1.57) and 1.10 (0.82-1.48).
the use of SBs is not associated with a lower fall risk compared with LBs. The use of both SBs and LBs by old persons should be strongly discouraged.