Association between Sleep Medicine & Falls in Nursing Homes

Nonbenzodiazepine sleep medication has been used increasingly at nursing homes to manage insomnia, a frequently diagnosed condition in such settings that has a negative impact on overall health and quality of life. While initially thought to be safer than traditional benzodiazepine medications in terms of fall risk, some research suggests that nonbenzodiazepine use may also increase the risk for falls. An article in the Journal of the American Medical Association Internal Medicine reports on a study of more than 15,000 long-stay nursing home residents that explores the effect of nonbenzodiazepine use on falls risk.

The study builds on previous research by factoring for a variety of individual and facility-level characteristics to control for existing falls risk. It was necessary to consider these factors because previously identified associations between nonbenzodiazepine use and falls may be a result of the likelihood that individuals who are administered such medications may be more likely to experience a fall, or that facilities with high rates of nonbenzodiazepine use may have other traits that increase falls risk.

Overall, the data showed a 66 percent increased risk for a hip fracture within 30 days of being administered nonbenzodiazepine sleep aids, with the greatest risk for injury occurring within the first 15 days of use. It is important to consider that insomnia itself is a risk factor for falls and injury, and observational studies such as this one cannot determine whether the insomnia itself or the drug use is the main contributing factor to increased falls risk. Future research may provide a better understanding of the risk of drug treatments for insomnia relative to the risks of insomnia itself.


Berry SD, Lee Y, Cai S, et al. Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents. JAMA Internal Medicine (2013). DOI:10.1001/jamainternmed.2013.3795


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