Nonbenzodiazepine Sleep Medication Use and Hip Fractures in Nursing Home Residents | Clinical Pharmacy and Pharmacology | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.204.227.34. Please contact the publisher to request reinstatement.
1.
Briesacher BA, Soumerai SB, Field TS, Fouayzi H, Gurwitz JH. Medicare Part D's exclusion of benzodiazepines and fracture risk in nursing homes.  Arch Intern Med. 2010;170(8):693-69820421554PubMedGoogle ScholarCrossref
2.
Wang PS, Bohn RL, Glynn RJ, Mogun H, Avorn J. Zolpidem use and hip fractures in older people.  J Am Geriatr Soc. 2001;49(12):1685-169011844004PubMedGoogle ScholarCrossref
3.
Finkle WD, Der JS, Greenland S,  et al.  Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults.  J Am Geriatr Soc. 2011;59(10):1883-189022091502PubMedGoogle ScholarCrossref
4.
Avidan AY, Fries BE, James ML, Szafara KL, Wright GT, Chervin RD. Insomnia and hypnotic use, recorded in the Minimum Data Set, as predictors of falls and hip fractures in Michigan nursing homes.  J Am Geriatr Soc. 2005;53(6):955-96215935017PubMedGoogle ScholarCrossref
5.
Intrator O, Hiris J, Berg K, Miller SC, Mor V. The residential history file: studying nursing home residents' long-term care histories.  Health Serv Res. 2011;46(1, pt 1):120-13721029090PubMedGoogle ScholarCrossref
6.
Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events.  Am J Epidemiol. 1991;133(2):144-1531985444PubMedGoogle Scholar
7.
Ray WA, Griffin MR, Fought RL, Adams ML. Identification of fractures from computerized Medicare files.  J Clin Epidemiol. 1992;45(7):703-7141619449PubMedGoogle ScholarCrossref
8.
Rigler SK, Ellerbeck E, Whittle J, Mahnken J, Cook-Wiens G, Shireman TI. Comparing methods to identify hip fracture in a nursing home population using Medicare claims.  Osteoporos Int. 2011;22(1):57-6120503037PubMedGoogle ScholarCrossref
9.
Morris JN, Hawes C, Fries BE,  et al.  Designing the national resident assessment instrument for nursing homes.  Gerontologist. 1990;30(3):293-3072354790PubMedGoogle ScholarCrossref
10.
Mor V, Angelelli J, Jones R, Roy J, Moore T, Morris J. Inter-rater reliability of nursing home quality indicators in the U.S.  BMC Health Serv Res. 2003;3(1):e20.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC280691/. Accessed January 5, 201314596684PubMedGoogle ScholarCrossref
11.
Mor V, Intrator O, Unruh MA, Cai S. Temporal and geographic variation in the validity and internal consistency of the nursing home resident assessment Minimum Data Set 2.0.  BMC Health Serv Res. 2011;11:e78.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097253/. Accessed January 5, 201321496257PubMedGoogle ScholarCrossref
12.
Hartmaier SL, Sloane PD, Guess HA, Koch GG, Mitchell CM, Phillips CD. Validation of the Minimum Data Set Cognitive Performance Scale: agreement with the Mini-Mental State Examination.  J Gerontol A Biol Sci Med Sci. 1995;50(2):M128-M133Google ScholarCrossref
13.
Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS.  J Gerontol A Biol Sci Med Sci. 1999;54(11):M546-M55310619316PubMedGoogle ScholarCrossref
14.
Strahan GW. An overview of nursing homes and their current residents: data from the 1995 National Nursing Home Survey.  Adv Data. 1997;(280):1-1210164984PubMedGoogle Scholar
15.
Schneeweiss S. Sensitivity analysis and external adjustment for unmeasured confounders in epidemiologic database studies of therapeutics.  Pharmacoepidemiol Drug Saf. 2006;15(5):291-30316447304PubMedGoogle ScholarCrossref
16.
Walker AM, edObservation and Inference. Newton, MA: Epidemiology Resources Inc; 1991
17.
Brown University Alpert Medical School.  Long-term care: facts on care in the US. 2012. http://ltcfocus.org/default.aspx. Accessed September 18, 2012
18.
Eom CS, Lee HK, Ye S, Park SM, Cho KH. Use of selective serotonin reuptake inhibitors and risk of fracture: a systematic review and meta-analysis.  J Bone Miner Res. 2012;27(5):1186-119522258738PubMedGoogle ScholarCrossref
19.
Stevenson DG, Decker SL, Dwyer LL,  et al.  Antipsychotic and benzodiazepine use among nursing home residents: findings from the 2004 National Nursing Home Survey.  Am J Geriatr Psychiatry. 2010;18(12):1078-109220808119PubMedGoogle ScholarCrossref
20.
Frey DJ, Ortega JD, Wiseman C, Farley CT, Wright KP Jr. Influence of zolpidem and sleep inertia on balance and cognition during nighttime awakening: a randomized placebo-controlled trial.  J Am Geriatr Soc. 2011;59(1):73-8121226678PubMedGoogle ScholarCrossref
21.
Kleykamp BA, Griffiths RR, McCann UD, Smith MT, Mintzer MZ. Acute effects of zolpidem extended-release on cognitive performance and sleep in healthy males after repeated nightly use.  Exp Clin Psychopharmacol. 2012;20(1):28-3921928913PubMedGoogle ScholarCrossref
22.
Walter LC, Lui LY, Eng C, Covinsky KE. Risk of hip fracture in disabled community-living older adults.  J Am Geriatr Soc. 2003;51(1):50-5512534845PubMedGoogle ScholarCrossref
23.
Girman CJ, Chandler JM, Zimmerman SI,  et al.  Prediction of fracture in nursing home residents.  J Am Geriatr Soc. 2002;50(8):1341-134712164989PubMedGoogle ScholarCrossref
24.
Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y. Falls among frail older people in residential care.  Scand J Public Health. 2002;30(1):54-6111928835PubMedGoogle Scholar
25.
Colón-Emeric CS, Biggs DP, Schenck AP, Lyles KW. Risk factors for hip fracture in skilled nursing facilities: who should be evaluated?  Osteoporos Int. 2003;14(6):484-48912730734PubMedGoogle ScholarCrossref
26.
Guttman R, Altman RD, Karlan MS.Council on Scientific Affairs, American Medical Association.  Report of the Council on Scientific Affairs: use of restraints for patients in nursing homes.  Arch Fam Med. 1999;8(2):101-10510101979PubMedGoogle ScholarCrossref
27.
Blake C, Morfitt JM. Falls and staffing in a residential home for elderly people.  Public Health. 1986;100(6):385-3913492007PubMedGoogle ScholarCrossref
28.
Klungel OH, Martens EP, Psaty BM,  et al.  Methods to assess intended effects of drug treatment in observational studies are reviewed.  J Clin Epidemiol. 2004;57(12):1223-123115617947PubMedGoogle ScholarCrossref
Original Investigation
May 13, 2013

Nonbenzodiazepine Sleep Medication Use and Hip Fractures in Nursing Home Residents

Author Affiliations

Author Affiliations: Institute for Aging Research, Hebrew SeniorLife, and Harvard Medical School, Boston, Massachusetts (Dr Berry); and Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island (Ms Lee and Drs Cai and Dore).

JAMA Intern Med. 2013;173(9):754-761. doi:10.1001/jamainternmed.2013.3795
Abstract

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.

×