Review| Volume 101, P17-22, July 2017

Relationship between the use of benzodiazepines and falls in older adults: A systematic review


      • An updated review is presented of the link between the use of benzodiazepines and falls in the elderly.
      • Benzodiazepines increase the risk of falling when used either as monotherapy or in combined therapies.
      • A high proportion of falls in older adults are related to the use of benzodiazepines.


      Falls in the elderly represent a major health problem. The etiology of falls is usually multifactorial. Special attention should be paid on benzodiazepines (BZDs) since they are widely used by older adults.
      A literature search of the PUBMED and EMBASE databases from January 2007 to February 2017 was conducted using the MeSH terms “benzodiazepines”, “elderly” and “falls” or “accidental falls”. The systematic review was performed according to PRISMA criteria.
      Of the 27 references selected for full reading from 235 found, 15 were eliminated and 12 papers were selected for systematic review.
      Exposure to BZDs was associated with a higher risk of falls in older adults, which is consistent with the results reported in the literature and previous reviews and meta-analyses. BZDs increase the risk of falling when used either as monotherapy or in combined therapies. It is preferable to use short-acting BZDs, to avoid cumulative effects over time predisposing to falls.
      A high proportion of falls in older adults are related to the use of BZDs. They should be prescribed to older patients in accordance with current clinical guidelines and reviewed over time. BZDs should be prescribed as a short-term therapy and progressively withdrawn. Short-acting BZDs should be the treatment of choice.


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        • Siracuse J.J.
        • Odell D.D.
        • Gondek S.P.
        • Odom S.R.
        • Kasper E.M.
        • Hauser C.J.
        • Moorman D.W.
        Health care and socioeconomic impact of falls in the elderly.
        Am. J. Surg. 2012; 203 (discussion 338): 335-338
      1. OMS. | Caídas, WHO. (n.d.). (Accessed September 9, 2016).

        • Pohl P.
        • Nordin E.
        • Lundquist A.
        • Bergström U.
        • Lundin-Olsson L.
        Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years-a prospective long-term follow-up study.
        BMC Geriatr. 2014; 14
        • Pellicer García B.
        • Juarez Vela R.
        • Gracia Carrasco E.
        • Guerrero Portillo S.
        • García Moyano L.M.
        • Azón Belarre J.C.
        Epidemiology of falls in the non-institutionalized spanish elderly population, systematic review 2014.
        Rev. Enferm. Barc. Spain. 2015; 38: 40-45
        • Chang J.T.
        • Ganz D.A.
        Quality indicators for falls and mobility problems in vulnerable elders.
        J. Am. Geriatr. Soc. 2007; 55: S327-S334
        • Rossat A.
        • Fantino B.
        • Bongue B.
        • Colvez A.
        • Nitenberg C.
        • Annweiler C.
        • Beauchet O.
        Association between benzodiazepines and recurrent falls: a cross-sectional elderly population-based study.
        J. Nutr. Health Aging. 2011; 15: 72-77
        • Pugh M.J.V.
        • Fincke B.G.
        • Bierman A.S.
        • Chang B.-H.
        • Rosen A.K.
        • Cunningham F.E.
        • Amuan M.E.
        • Burk M.L.
        • Berlowitz D.R.
        Potentially inappropriate prescribing in elderly veterans: are we using the wrong drug, wrong dose, or wrong duration?.
        J. Am. Geriatr. Soc. 2005; 53: 1282-1289
        • McLachlan A.J.
        • Pont L.G.
        Drug metabolism in older people-a key consideration in achieving optimal outcomes with medicines.
        J. Gerontol. A Biol. Sci. Med. Sci. 2012; 67: 175-180
        • Gray S.L.
        • Penninx B.W.J.H.
        • Blough D.K.
        • Artz M.B.
        • Guralnik J.M.
        • Wallace R.B.
        • Buchner D.M.
        • LaCroix A.Z.
        Benzodiazepine use and physical performance in community-dwelling older women.
        J. Am. Geriatr. Soc. 2003; 51: 1563-1570
        • Woolcott J.C.
        • Richardson K.J.
        • Wiens M.O.
        • Patel B.
        • Marin J.
        • Khan K.M.
        • Marra C.A.
        Meta-analysis of the impact of 9 medication classes on falls in elderly persons.
        Arch. Intern. Med. 2009; 169: 1952-1960
        • Medina-Chávez J.H.
        • Fuentes-Alexandro S.A.
        • Gil-Palafox I.B.
        • Adame-Galván L.
        • Solís-Lam F.
        • Sánchez-Herrera L.Y.
        • Sánchez-Narváez F.
        Instituto Mexicano del seguro social, clinical practice guideline. Diagnosis and treatment of insomnia in the elderly.
        Rev. Med. Inst. Mex. Seguro Soc. 2014; 52: 108-119
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        J. Clin. Epidemiol. 2009; 62: 1006-1012
      2. OSTEBA, Servicio de Evaluación de Tecnologías Sanitarias. Departamento de Salud, Gobierno Vasco, España., Fichas de Lectura Crítica. Plataforma Web 2.0, (n.d.).

        • Landi F.
        • Onder G.
        • Cesari M.
        • Barillaro C.
        • Russo A.
        • Bernabei R.
        • Silver Network Home Care Study Group
        Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study.
        J. Gerontol. A Biol. Sci. Med. Sci. 2005; 60: 622-626
        • Tängman S.
        • Eriksson S.
        • Gustafson Y.
        • Lundin-Olsson L.
        Precipitating factors for falls among patients with dementia on a psychogeriatric ward.
        Int. Psychogeriatr. IPA. 2010; 22: 641-649
        • Sylvestre M.-P.
        • Abrahamowicz M.
        • Čapek R.
        • Tamblyn R.
        Assessing the cumulative effects of exposure to selected benzodiazepines on the risk of fall-related injuries in the elderly.
        Int. Psychogeriatr. IPA. 2012; 24: 577-586
        • Ballokova A.
        • Peel N.M.
        • Fialova D.
        • Scott I.A.
        • Gray L.C.
        • Hubbard R.E.
        Use of benzodiazepines and association with falls in older people admitted to hospital: a prospective cohort study.
        Drugs Aging. 2014; 31: 299-310
        • Richardson K.
        • Bennett K.
        • Kenny R.A.
        Polypharmacy including falls risk-increasing medications and subsequent falls in community-dwelling middle-aged and older adults.
        Age Ageing. 2015; 44: 90-96
        • Ham A.C.
        • Swart K.M.A.
        • Enneman A.W.
        • van Dijk S.C.
        • Oliai Araghi S.
        • van Wijngaarden J.P.
        • van der Zwaluw N.L.
        • Brouwer-Brolsma E.M.
        • Dhonukshe-Rutten R.A.M.
        • van Schoor N.M.
        • van der Cammen T.J.M.
        • Lips P.
        • de Groot L.C.P.G.M.
        • Uitterlinden A.G.
        • Witkamp R.F.
        • Stricker B.H.
        • van der Velde N.
        Medication-related fall incidents in an older, ambulant population: the B-PROOF study.
        Drugs Aging. 2014; 31: 917-927
        • Pariente A.
        • Dartigues J.-F.
        • Benichou J.
        • Letenneur L.
        • Moore N.
        • Fourrier-Réglat A.
        Benzodiazepines and injurious falls in community dwelling elders.
        Drugs Aging. 2008; 25: 61-70
        • Ray W.A.
        • Thapa P.B.
        • Gideon P.
        Benzodiazepines and the risk of falls in nursing home residents.
        J. Am. Geriatr. Soc. 2000; 48: 682-685
        • Glass J.R.
        • Sproule B.A.
        • Herrmann N.
        • Busto U.E.
        Effects of 2-week treatment with temazepam and diphenhydramine in elderly insomniacs: a randomized, placebo-controlled trial.
        J. Clin. Psychopharmacol. 2008; 28: 182-188
        • Leclerc B.S.
        • Bégin C.
        • Cadieux E.
        • Goulet L.
        • Leduc N.
        • Kergoat M.-J.
        • Lebel P.
        Risk factors for falling among community-dwelling seniors using home-care services: an extended hazards model with time-dependent covariates and multiple events.
        Chron. Dis. Can. 2008; 28: 111-120
        • Berdot S.
        • Bertrand M.
        • Dartigues J.-F.
        • Fourrier A.
        • Tavernier B.
        • Ritchie K.
        • Alpérovitch A.
        Inappropriate medication use and risk of falls-a prospective study in a large community-dwelling elderly cohort.
        BMC Geriatr. 2009; 9
        • Berry S.D.
        • Placide S.G.
        • Mostofsky E.
        • Zhang Y.
        • Lipsitz L.A.
        • Mittleman M.A.
        • Kiel D.P.
        Antipsychotic and benzodiazepine drug changes affect acute falls risk differently in the nursing home.
        J. Gerontol. A Biol. Sci. Med. Sci. 2016; 71: 273-278
        • Neutel C.I.
        • Skurtveit S.
        • Berg C.
        What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population.
        Sleep Med. 2012; 13: 893-897
        • Ungar A.
        • Rafanelli M.
        • Iacomelli I.
        • Brunetti M.A.
        • Ceccofiglio A.
        • Tesi F.
        • Marchionni N.
        Fall prevention in the elderly.
        Clin. Cases Miner. Bone Metab. 2013; 10: 91-95
        • Balon R.
        • Fava G.A.
        • Rickels K.
        Need for a realistic appraisal of benzodiazepines.
        World Psychiatry. 2015; 14: 243-244
        • Martinez-Cengotitabengoa M.
        • Diaz-Gutierrez M.J.
        • Besga A.
        • Bermúdez-Ampudia C.
        • López P.
        • Rondon M.B.
        • Stewart D.E.
        • Perez P.
        • Gutierrez M.
        • Gonzalez-Pinto A.
        Benzodiazepine prescriptions and falls in older men and women.
        Rev. Psiquiatr. Salud Ment. 2017;
        • By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel
        American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults.
        J. Am. Geriatr. Soc. 2015; 63: 2227-2246
        • Finkle W.D.
        • Der J.S.
        • Greenland S.
        • Adams J.L.
        • Ridgeway G.
        • Blaschke T.
        • Wang Z.
        • Dell R.M.
        • VanRiper K.B.
        Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults.
        J. Am. Geriatr. Soc. 2011; 59: 1883-1890
        • van Strien A.M.
        • Koek H.L.
        • van Marum R.J.
        • Emmelot-Vonk M.H.
        Psychotropic medications, including short acting benzodiazepines, strongly increase the frequency of falls in elderly.
        Maturitas. 2013; 74: 357-362
        • Gunja N.
        In the Zzz zone: the effects of Z-drugs on human performance and driving.
        J. Med. Toxicol. 2013; 9: 163-171
        • Marcum Z.A.
        • Perera S.
        • Thorpe J.M.
        • Switzer G.E.
        • Castle N.G.
        • Strotmeyer E.S.
        • Simonsick E.M.
        • Ayonayon H.N.
        • Phillips C.L.
        • Rubin S.
        • Zucker-Levin A.R.
        • Bauer D.C.
        • Shorr R.I.
        • Kang Y.
        • Gray S.L.
        • Hanlon J.T.
        • Health ABC study
        Antidepressant use and recurrent falls in community-dwelling older adults: findings from the health ABC study.
        Ann. Pharmacother. 2016; 50: 525-533
        • Milos V.
        • Bondesson Å.
        • Magnusson M.
        • Jakobsson U.
        • Westerlund T.
        • Midlöv P.
        Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care.
        BMC Geriatr. 2014; 14
        • French D.D.
        • Chirikos T.N.
        • Spehar A.
        • Campbell R.
        • Means H.
        • Bulat T.
        Effect of concomitant use of benzodiazepines and other drugs on the risk of injury in a veterans population.
        Drug Saf. 2005; 28: 1141-1150
        • Bénard-Laribière A.
        • Noize P.
        • Pambrun E.
        • Bazin F.
        • Verdoux H.
        • Tournier M.
        • Bégaud B.
        • Pariente A.
        Comorbidities and concurrent medications increasing the risk of adverse drug reactions: prevalence in French benzodiazepine users.
        Eur. J. Clin. Pharmacol. 2016; 72: 869-876
        • Bourin M.
        The problems with the use of benzodiazepines in elderly patients.
        L’Encéphale. 2010; 36: 340-347
        • Wu C.-S.
        • Wang S.-C.
        • Chang I.-S.
        • Lin K.-M.
        The association between dementia and long-term use of benzodiazepine in the elderly: nested case-control study using claims data.
        Am. J. Geriatr. Psychiatry. 2009; 17: 614-620
        • Zhang Y.
        • Zhou X.-H.
        • Meranus D.H.
        • Wang L.
        • Kukull W.A.
        Benzodiazepine use and cognitive decline in elderly with normal cognition.
        Alzheimer Dis. Assoc. Disord. 2016; 30: 113-117
        • Wu C.-S.
        • Ting T.-T.
        • Wang S.-C.
        • Chang I.-S.
        • Lin K.-M.
        Effect of benzodiazepine discontinuation on dementia risk.
        Am. J. Geriatr. Psychiatry. 2011; 19: 151-159
        • Bartlett G.
        • Abrahamowicz M.
        • Grad R.
        • Sylvestre M.-P.
        • Tamblyn R.
        Association between risk factors for injurious falls and new benzodiazepine prescribing in elderly persons.
        BMC Fam. Pract. 2009; 10
        • Salzman C.
        • Shader R.I.
        Benzodiazepine use and risk for Alzheimer disease.
        J. Clin. Psychopharmacol. 2015; 35: 1-3
      3. B. McIntosh, M. Clark, C. Spry, Benzodiazepines in Older Adults: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines, Canadian Agency for Drugs and Technologies in Health, Ottawa (ON), 2011. (Accessed September 1, 2015).

        • Kline N.E.
        • Davis M.E.
        • Thom B.
        Fall risk assessment and prevention.
        Oncol. Williston Park N. 2011; 25: 17-22
        • Savaskan E.
        Benzodiazepine dependency in the elderly: how to deal with it.
        Praxis. 2016; 105: 637-641
        • Janhsen K.
        • Roser P.
        • Hoffmann K.
        The problems of long-term treatment with benzodiazepines and related substances.
        Dtsch. Ärztebl. Int. 2015; 112: 1-7
        • Hanlon J.T.
        • Boudreau R.M.
        • Roumani Y.F.
        • Newman A.B.
        • Ruby C.M.
        • Wright R.M.
        • Hilmer S.N.
        • Shorr R.I.
        • Bauer D.C.
        • Simonsick E.M.
        • Studenski S.A.
        Number and dosage of central nervous system medications on recurrent falls in community elders: the Health, Aging and Body Composition study.
        J. Gerontol. A Biol. Sci. Med. Sci. 2009; 64: 492-498
        • Starcevic V.
        The reappraisal of benzodiazepines in the treatment of anxiety and related disorders.
        Expert Rev. Neurother. 2014; 14: 1275-1286
        • Markota M.
        • Rummans T.A.
        • Bostwick J.M.
        • Lapid M.I.
        Benzodiazepine use in older adults: dangers, management, and alternative therapies.
        Mayo Clin. Proc. 2016; 91: 1632-1639