Benzodiazepines with different half-life and falling in a hospitalized population: the GIFA study

Abstract In recent years, the use of benzodiazepines has been recognized as an independent risk factor for falls among the elderly. To evaluate the role of different types of benzodiazepines in determining falls in a hospitalized geriatric population, we conducted a prospective study among 7908 patients consecutively admitted in 58 clinical centers of the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA), during an 8-month observation period (1991 and 1993). Over 70% of the patients were older than 65 years, 50% were women, and 23.6% had a benzodiazepine prescription during hospital stay. The number of patients who experienced one or more falls during follow-up was 174 (2.2%). Sixty falls occurred among patients taking benzodiazepines (3.2%) and 114 (1.9%) among those who did not use benzodiazepines; the crude odds ratio for users versus non-users was 1.7 (95% CI 1.2–2.3). Multivariate logistic regression analysis showed that benzodiazepines with very short (OR 1.9; CI 1.03–3.3) and short half-life (OR 1.8; CI 1.2–2.8) were positively associated with falls during hospital stay. Patients who used other psychotropic agents (OR 2.3; CI 1.7–3.4), antidiabetic agents (OR 1.5; CI 1.03–2.2), patients with presence of cognitive impairment (OR 1.6; CI 1.08–2.3), high level of comorbidity (OR 1.7; CI 1.05–2.9), more advanced age (>80 years, OR 2.7; CI 1.5–4.7) and those who stayed in the hospital for 17 days or more (OR 2.1; CI 1.4–3.3) were also at a greater risk. These findings suggest that benzodiazepines with short and very short half-life are an important and independent risk factor for falls and their prescription to elderly hospitalized patients should be carefully evaluated.