Insomnia and Hypnotic Use, Recorded in the Minimum Data Set, as Predictors of Falls and Hip Fractures in Michigan Nursing Homes Alon Y. Avidan, MD, MPH, à Brant E. Fries, PhD, wz § Mary L. James, MA, w Kristina L. Szafara, PhD, w Glenn T. Wright, BS, w and Ronald D. Chervin, MD, MS à OBJECTIVES: To examine the relationship between in- somnia, hypnotic use, falls, and hip fractures in older people. DESIGN: Secondary analysis of a large, longitudinal, as- sessment database. SETTING: Four hundred thirty-seven nursing homes in Michigan. PARTICIPANTS: Residents aged 65 and older in 2001 with a baseline Minimum Data Set assessment and a follow- up 150 to 210 days later. MEASUREMENTS: Logistic regression modeled any fol- low-up report of fall or hip fracture. Predictors were base- line reports of insomnia (previous month) and use of hypnotics (previous week). Potential confounds taken into account included standard measures of functional status, cognitive status, intensity of resource utilization, proximity to death, illness burden, number of medications, emergency room visits, nursing home new admission, age, and sex. RESULTS: In 34,163 nursing home residents (76% wom- en, mean age  standard deviation 84  8), hypnotic use did not predict falls (adjusted odds ratio (AOR) 5 1.13, 95% confidence interval (CI) 5 0.98, 1.30). In contrast, in- somnia did predict future falls (AOR 5 1.52, 95% CI 5 1.38, 1.66). Untreated insomnia (AOR 5 1.55, 95% CI 5 1.41, 1.71) and hypnotic-treated (unresponsive) in- somnia (AOR 5 1.32, 95% CI 5 1.02, 1.70) predicted more falls than did the absence of insomnia. After adjust- ment for confounding variables, insomnia and hypnotic use were not associated with subsequent hip fracture. CONCLUSION: In elderly nursing home residents, insom- nia, but not hypnotic use, is associated with a greater risk of subsequent falls. Future studies will need to confirm these findings and determine whether appropriate hypnotic use can protect against future falls. J Am Geriatr Soc 53:955–962, 2005. Key words: insomnia; accidental falls; hip fractures; aged; nursing homes; Minimum Data Set; interRAI M ore than one-third of adults aged 65 and older fall each year. 1 In this age group, falls are the leading cause of injury-related deaths 2 and the most common cause of nonfatal injuries and hospital admissions for trauma. 3 About 1% of falls result in hip fractures that cause restrict- ed mobility for 60%, increased functional dependence for 25%, death within 6 months for 25%, and annual medical costs of $2 billion. 4 Among the many causes of falls in older persons are medical conditions, impaired vision and hear- ing, misuse of assistive devices, environmental factors, and medications. Of medications commonly used by older persons, psy- chotropic agents and hypnotics in particular have been im- plicated as strong risk factors for falls. 5–8 In a community setting, psychotropic or sedative use increased the likeli- hood of falls by a factor of 28.3 (95% confidence interval (CI) 5 3.4–239.4), after controlling for some other risk fac- tors. 9 In comparison, cognitive impairment only increased fall risk by a factor of 5.0 (95% CI 5 1.8–13.7) and mul- tiple balance and gait abnormalities by a factor of 1.9 (95% CI 5 1.0–3.7). Sedatives can impair posture, reaction time, coordination, protective responses during falls, and cardio- vascular reflexes that normally prevent orthostatic hypo- tension, 10–12 but much of the measured effect of sedative use also may be attributable to unmeasured health condi- tions and practices common in sedative usersFinclud- ing comorbidities, decreased coordination, cognitive This study was supported, in part, by the National Institute of Aging through the Older Americans Independence Grant P60 A608808-10 and Training Grant T32 AG00114. Presented preliminarily and in part at the Meeting of the Associated Professional Sleep Societies, Philadelphia, Pennsylvania, June 2004, and the Gerontological Society of America, Washington, DC, November 2004. Address correspondence to Alon Y. Avidan, MD, MPH, Michael S. Aldrich Sleep Laboratory, 8D-8702 University Hospital, Box 0117, 1500 East Medical Center Drive, Ann Arbor, MI 48109. E-mail: avidana@umich.edu DOI: 10.1111/j.1532-5415.2005.53304.x From the à Sleep Disorders Center, Department of Neurology, w Institute of Gerontology, and z School of Public Health, University of Michigan, Ann Arbor, Michigan; and § Geriatric Research, Education and Clinical Center, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan. JAGS 53:955–962, 2005 r 2005 by the American Geriatrics Society 0002-8614/05/$15.00