ORIGINAL RESEARCH ARTICLE Use of Benzodiazepines and Association with Falls in Older People Admitted to Hospital: A Prospective Cohort Study Anna Ballokova • Nancye M. Peel • Daniela Fialova • Ian A. Scott • Leonard C. Gray • Ruth E. Hubbard Published online: 25 February 2014 Ó Springer International Publishing Switzerland 2014 Abstract Background Hypnosedatives are commonly prescribed for anxiety and sleep problems. Changes in pharmacoki- netics and pharmacodynamics of benzodiazepines (BZDs) during ageing may increase their potential to cause adverse outcomes. Objective This study aimed to investigate the use of BZDs in acute care settings and explore their association with falls. Methods A prospective cohort study was undertaken of patients aged over 70 years consecutively admitted to 11 acute care hospitals in Australia. Data were collected using the interRAI Acute Care assessment tool. Falls were recorded prospectively (in hospital) and retrospectively (in the 90 days prior to admission). Results Of 1,412 patients, 146 (10.3 %) were taking BZDs at admission and 155 (11.3 %) at discharge. Inci- dence rates of in-hospital fallers for users and non-users of BZDs were not statistically different [incidence rate ratio 1.03, 95 % confidence interval (CI) 0.58–1.82]. There was also no significant association between benzodiazepine use at admission and history of falls in the previous 90 days compared with non-users. However, patients on diazepam were significantly more likely to have a history of falls than all other benzodiazepine users (70.8 vs. 36.1 %; p = 0.002), particularly when compared with oxazepam users (70.8 vs. 25.0 %; p \ 0.001). Adjusting for con- founders, use of diazepam at admission was positively associated with a history of falls compared with all other benzodiazepine users (odds ratio 3.0; 95 % CI 1.1–8.5; p = 0.036). Conclusions Different BZDs may vary in their propensity to predispose to falls, with diazepam having the strongest association. The selection of particular BZDs for older patients should be carefully evaluated. 1 Introduction Benzodiazepines (BZDs) are prescribed for a number of conditions, including anxiety disorders, insomnia, alcohol withdrawal, depression, and muscle spasms [1]. BZDs are widely used among older community-dwelling people, with estimated prevalence varying from 10 to 32 % [2–5]. A recent Australian study of 337 community-dwelling people over 75 years found a prevalence of long-term BZD use of 16.6 % at first assessment and 19.6 % at 3- and 4.5- year follow-up [3]. Smith and Tett [6] conducted a study of changes in utilization of antidepressants and BZDs between different age groups within the general Australia A. Ballokova (&) Á D. Fialova Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University in Prague, Londy ´nska ´ 15, 128 08 Prague, Czech Republic e-mail: anna.ballokova@seznam.cz N. M. Peel Á L. C. Gray Á R. E. Hubbard Centre for Research in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, QLD, Australia D. Fialova Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Prague, Czech Republic I. A. Scott School of Medicine, The University of Queensland, Brisbane, QLD, Australia I. A. Scott Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, QLD, Australia Drugs Aging (2014) 31:299–310 DOI 10.1007/s40266-014-0159-3