Document Detail

Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents.
MedLine Citation:
PMID:  23460413     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: It is important to understand the relationship between sleep medication use and injurious falls in nursing home residents.
OBJECTIVE: To conduct a case-crossover study to estimate the association between nonbenzodiazepine hypnotic drug use (zolpidem tartrate, eszopiclone, or zaleplon) and the risk for hip fracture among a nationwide sample of long-stay nursing home residents, overall and stratified by individual and facility-level characteristics.
DESIGN AND SETTING: Case-crossover study performed in an academic research setting.
PARTICIPANTS: The study participants included 15,528 long-stay US nursing home residents 50 years or older with a hip fracture documented in Medicare Part A and Part D fee-for-service claims between July 1, 2007, and December 31, 2008.
MAIN OUTCOME MEASURES: Odds ratios (ORs) of hip fracture were estimated using conditional logistic regression models by comparing the exposure to nonbenzodiazepine hypnotic drugs during the 0 to 29 days before the hip fracture (hazard period) with the exposure during the 60 to 89 and 120 to 149 days before the hip fracture (control periods). Analyses were stratified by individual and facility-level characteristics.
RESULTS: Among the study participants, 1715 (11.0%) were dispensed a nonbenzodiazepine hypnotic drug before the hip fracture, with 927 exposure-discordant pairs included in the analyses. The mean (SD) age of participants was 81.0 (9.7) years, and 77.6% were female. The risk for hip fracture was elevated among users of a nonbenzodiazepine hypnotic drug (OR, 1.66; 95% CI, 1.45-1.90). The association between nonbenzodiazepine hypnotic drug use and hip fracture was somes greater in new users (OR, 2.20; 95% CI, 1.76-2.74) and in residents with mild vs moderate to severe impairment in cognition (OR, 1.86 vs 1.43; P = .06), with moderate vs total or severe functional impairment (OR, 1.71 vs 1.16; P = .11), with limited vs full assistance required with transfers (OR, 2.02 vs 1.43; P = .02), or in a facility with fewer Medicaid beds (OR, 1.90 vs 1.46; P = .05).
CONCLUSIONS AND RELEVANCE: The risk for hip fracture is elevated among nursing home residents using a nonbenzodiazepine hypnotic drug. New users and residents having mild to moderate cognitive impairment or requiring limited assistance with transfers may be most vulnerable to the use of these drugs. Caution should be exercised when prescribing sleep medications to nursing home residents.
Sarah D Berry; Yoojin Lee; Shubing Cai; David D Dore
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-06-07     Completed Date:  2013-07-15     Revised Date:  2013-12-23    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  754-61     Citation Subset:  AIM; IM    
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MeSH Terms
Administration, Oral
Aged, 80 and over
Cross-Over Studies
Drug Prescriptions / statistics & numerical data*
Hip Fractures / epidemiology*,  etiology*
Hypnotics and Sedatives / administration & dosage*,  adverse effects*
Logistic Models
Middle Aged
Mild Cognitive Impairment / complications
Moving and Lifting Patients / adverse effects
Nursing Homes / statistics & numerical data*
Odds Ratio
United States / epidemiology
Grant Support
5P01AG027296-05/AG/NIA NIH HHS; K23 AG033204/AG/NIA NIH HHS; K23AG033204/AG/NIA NIH HHS; P01 AG027296/AG/NIA NIH HHS
Reg. No./Substance:
0/Hypnotics and Sedatives
Comment In:
JAMA Intern Med. 2013 Nov 11;173(20):1930-1   [PMID:  24217386 ]
JAMA Intern Med. 2013 Nov 11;173(20):1930   [PMID:  24217385 ]
JAMA Intern Med. 2013 May 13;173(9):761-2   [PMID:  23459766 ]

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