Duke University School of Medicine, Durham, NC, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Drugs Aging. 2024 Oct;41(10):809-819. doi: 10.1007/s40266-024-01144-7. Epub 2024 Sep 18.
Benzodiazepines and z-drugs increase the fall risk in older adults. There is a lack of real-world data examining the association between falls and deprescribing medications.
In a retrospective cohort study of older adults with chronic benzodiazepine or z-drug use receiving care at an academic health system from January 2017 to December 2020, we explored the association between medication discontinuation and falls.
Chronic use was defined as ≥ 3 medication dispensings and cumulative days' supply ≥ 45 days within 100 days in 2018. Discontinuation was defined as a dispensing gap of ≥ 180 days within 1 year of chronic use eligibility, with a secondary definition requiring a gap of ≥ 90 days. Non-discontinuers (n = 524) were matched 4:1 to discontinuers (n = 131) if they had a fill in the same month as the matched discontinuation index date. The association between discontinuation and a fall during 2.25-year follow-up was assessed using Cox proportional hazards models. The analysis was repeated using a gap of ≥ 90 days (n = 279 discontinuers; 1116 matched non-discontinuers).
The cumulative incidence of falls-related acute visits was 6.9% for discontinuers and 9.7% for non-discontinuers [adjusted hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.31-1.31]. Using the 90-day-gap definition, the cumulative incidence was 9.3% for discontinuers and 8.5% for non-discontinuers (HR 1.12, 95% CI 0.70-1.77).
Benzodiazepine/z-drug discontinuation was not associated with reduced risk of falls. However, the relationship between discontinuation and falls varies depending on the definitions used. It is essential to examine different discontinuation definitions in larger studies while considering other relevant clinical outcomes.
苯二氮䓬类药物和 Z 类药物会增加老年人跌倒的风险。目前缺乏真实世界的数据来研究跌倒与减少这些药物使用之间的关联。
在 2017 年 1 月至 2020 年 12 月期间，我们对在学术医疗系统接受治疗的慢性使用苯二氮䓬类药物或 Z 类药物的老年患者进行了回顾性队列研究，旨在探讨药物停用与跌倒之间的关系。
慢性使用定义为在 2018 年的 100 天内，≥3 次药物配给且累计用药天数≥45 天。停药定义为在慢性使用资格的 1 年内，配药间隔≥180 天，第二个定义要求间隔≥90 天。如果非停药者（n=524）与停药者（n=131）在同月有一次配药，则将其按 4：1 匹配到停药者。使用 Cox 比例风险模型评估 2.25 年随访期间停药与跌倒之间的关系。使用间隔≥90 天（n=279 名停药者；1116 名匹配的非停药者）重复该分析。
停药者发生与跌倒相关的急性就诊的累积发生率为 6.9%，而非停药者为 9.7%[调整后的危险比（HR）0.65，95%置信区间（CI）0.31-1.31]。使用 90 天间隔定义时，停药者的累积发生率为 9.3%，而非停药者为 8.5%（HR 1.12，95% CI 0.70-1.77）。
苯二氮䓬类药物/Z 类药物的停药与跌倒风险降低无关。然而，停药与跌倒之间的关系取决于所使用的定义。在更大的研究中，检查不同的停药定义并考虑其他相关临床结局是很重要的。
