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Study, Mar/21: Risk of In-Hospital Falls among Meds Commonly Used for Insomnia


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The full title of this American study is "Risk of In-Hospital Falls Among Medications Commonly Used for Insomnia in Hospitalized Patients".

 

https://pubmed.ncbi.nlm.nih.gov/33710329/

 

Note: Diphenhydramine, one of the medications that was studied, is an antihistamine. Also, while there is no mention of loss of balance or dizziness in this abstract, it is well-documented that the medications studied here affect balance, and it is the loss of balance that undoubtedly contributes greatly to the falls. There may be other contributing factors as well. The full paper may include such details, but I do not have access to it.

 

Abstract

 

Study objectives: To investigate the risk of in-hospital falls among patients receiving medications commonly used for insomnia in the hospital setting.

 

Methods: Retrospective cohort study of all adult hospitalizations to a large academic medical center from 1/2007 to 7/2013. We excluded patients admitted for a primary psychiatric disorder. Medication exposures of interest, defined by pharmacy charges, included benzodiazepines, non-benzodiazepine benzodiazepine receptor agonists (BZRAs), trazodone, atypical antipsychotics, and diphenhydramine. In-hospital falls were ascertained from an online patient safety reporting system.

 

Results: Among the 225,498 hospitalizations (median age = 57 years; 57.9% female) in our cohort, 84,911 (37.7%) had exposure to at least one of the five medication classes of interest; benzodiazepines were the most commonly used (23.5%), followed by diphenydramine (8.3%), trazodone (6.6%), BZRAs (6.4%), and atypical antipsychotics (6.3%). A fall occurred in 2,427 hospitalizations (1.1%). The rate of falls per 1,000 hospital days was greater among hospitalizations with exposure to each of the medications of interest, compared to unexposed: 3.6 versus 1.7 for benzodiazepines (adjusted hazard ratio [aHR] 1.8, 95%CI 1.6-1.9); 5.4 versus 1.8 for atypical antipsychotics (aHR 1.6, 95%CI 1.4-1.8 ); 3.0 versus 2.0 for BZRAs (aHR 1.5, 95%CI 1.3-1.8 ); 3.3 versus 2.0 for trazodone (aHR 1.2, 95%CI 1.1-1.5); and 2.5 versus 2.0 for diphenhydramine (aHR 1.2, 95%CI 1.03-1.5).

 

Conclusions: In this large cohort of hospitalizations at an academic medical center, we found an association between each of the sedating medications examined and in-hospital falls. Benzodiazepines, BZRAs, and atypical antipsychotics had the strongest associations.

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I'm reminded of a time when my medical team wanted to prevent me from sleeping and the machines that were used after my last surgery for the repair and replacement of some titanium parts located in one of my legs. The many machines which were attached to my body likely monitored my respiration and heart rate among other things. I was enabled to self administer small doses of pain medication but, every time I started to doze off for even a few seconds, very bright flashing lights and loud alarms that were focused and directed toward my head would prevent me from receiving any sort of sleeping states. I was told by the anesthesiologist's assistant that the only way for me to make the visual and audio assaults stop was to raise my respiration and heart rate by blowing air onto a thin strip of paper that was fastened to my head and dangled down to near my lips. The machines must have been put in place sometime before the surgery and they were not removed for almost 24 hours post surgery, after the anesthesiologist was satisfied that the drugs used during surgery were sufficiently out of my system so as not to hinder my natural respiration and heart function. I wanted to sleep so badly that I stopped using the machine that was provided to me for the self administration of pain medication hoping that would somehow affect the machines which prevented me from falling asleep. The procedures seemed torturous at the time but, the surgery was successful, I'm able to lead a good functional life, enjoy good times with family and friends and I'm still here to tell people about it.

 

Nothing about living is risk free. 

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