Benzodiazepines and the risk of falls in nursing home residents

J Am Geriatr Soc. 2000 Jun;48(6):682-5. doi: 10.1111/j.1532-5415.2000.tb04729.x.


Context: For nursing home residents who require a benzodiazepine, short-acting agents are recommended, primarily to avoid increased risk of falls and other injuries associated with the long-acting agents. However, much of the data for the clinical outcomes of falls and injuries comes from community-dwelling older people.

Objective: To quantify the rate of falls among nursing home residents taking benzodiazepines and how this varies with drug elimination half-life.

Design: Historical cohort study.

Population: A total of 2510 residents of 53 Tennessee nursing homes, classified according to benzodiazepine use on each day of follow-up.

Outcome measures: Falls occurring during study follow-up.

Results: After adjustment for differences in resident characteristics, benzodiazepine users had a 44% increased rate of falls (adjusted rate ratio 1.44 [95% confidence interval, 1.33-1.56]). The adjusted rate ratio increased from 1.30 (1.12-1.52) for a dose equivalent to < or = 2 mg of diazepam, to 2.21 (1.89-2.60, P < .001) for a dose of > 8 mg. The rate of falls was greatest in the 7 days after the benzodiazepine was started (rate ratio of 2.96 [2.33-3.75]) but remained elevated (1.30 [1.17-1.44]) after the first 30 days of therapy. Drugs with elimination half-lives of <12, 12-23, and > or = 24 hours had adjusted rate ratios of 1.15 (0.94-1.40), 1.45 (1.33-1.59), and 1.73 (1.40-2.14), respectively. Users of hypnotics with elimination half-lives <12 hours had an increased rate of falls occurring during the night (adjusted rate ratio 2.82 [2.02-3.94]).

Conclusions: Although the risk of falls among nursing home residents receiving short-acting benzodiazepines is less than that for the long-acting agents, these drugs are associated with a materially increased risk of nocturnal falls.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Accidental Falls / prevention & control*
  • Accidental Falls / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Anti-Anxiety Agents / adverse effects*
  • Anti-Anxiety Agents / pharmacokinetics
  • Benzodiazepines
  • Follow-Up Studies
  • Frail Elderly*
  • Half-Life
  • Homes for the Aged*
  • Humans
  • Nursing Homes*
  • Poisson Distribution
  • Regression Analysis
  • Risk Factors
  • Tennessee


  • Anti-Anxiety Agents
  • Benzodiazepines