• Bhanu Prakash Kolla, Jenna K Lovely, Meghna P Mansukhani, and Timothy I Morgenthaler.
• Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
• J Hosp Med. 2013 Jan 1; 8 (1): 1-6.

BackgroundInpatient falls are associated with significant morbidity and increased healthcare costs. Zolpidem has been reported to decrease balance and is associated with falls. Yet, it is a commonly used hypnotic agent in the inpatient setting. Zolpidem use in hospitalized patients may be a significant and potentially modifiable risk factor for falling.ObjectiveTo determine whether inpatients administered zolpidem are at greater risk of falling.DesignRetrospective cohort study.SettingAdult non-intensive care unit (non-ICU) inpatients at a tertiary care center.MethodsAdult inpatients who were prescribed zolpidem were identified. Electronic medical records were reviewed to capture demographics and other risk factors for falls. The fall rate was compared in those administered zolpidem versus those only prescribed zolpidem. Multivariate analyses were performed to determine whether zolpidem was independently associated with falls.ResultsThe fall rate among patients who were prescribed and received zolpidem (n = 4962) was significantly greater than among patients who were prescribed but did not receive zolpidem (n = 11,358) (3.04% vs 0.71%; P < 0.001). Zolpidem use continued to remain significantly associated with increased fall risk after accounting for age, gender, insomnia, delirium status, dose of zolpidem, Charlson comorbidity index, Hendrich's fall risk score, length of hospital stay, presence of visual impairment, gait abnormalities, and dementia/cognitive impairment (adjusted odds ratio [OR] 4.37, 95% confidence interval [CI] = 3.34-5.76; P < 0.001). Additionally, patients taking zolpidem who experienced a fall did not differ from other hospitalized adult patients who fell in terms of age, opioids, antidepressants, sedative-antidepressants, antipsychotics, benzodiazepine, or antihistamine use.ConclusionZolpidem use was a strong, independent, and potentially modifiable risk factor for inpatient falls.Copyright © 2012 Society of Hospital Medicine.

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