Effect of standardized hypnotic bundles on insomnia during hospitalization and reducing fall rate: A single‐center retrospective cohort study

• Published in: Geriatrics & gerontology international 2024-11, Vol.24 (11), p.1144-1149
• Main Authors: Yoshino, Yuta, Fudaka, Naoko, Shibasaki, Yumiko, Ogawa, Miyuki, Watanabe, Yoshimasa
• Format: Article
• Language: English
• Subjects: Accidental Falls - prevention & control; Accidental Falls - statistics & numerical data; Aged; Aged, 80 and over; Azepines - therapeutic use; Benzodiazepines; Cohort analysis; Cohort Studies; COVID-19 - epidemiology; COVID-19 - prevention & control; falls; Female; Hospitalization; Hospitalization - statistics & numerical data; Humans; Hypnotherapy; hypnotic bundle; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Injuries; Insomnia; Male; Middle Aged; Retrospective Studies; Risk factors; Sleep Initiation and Maintenance Disorders - drug therapy; Sleep Initiation and Maintenance Disorders - epidemiology; Triazoles
• ISSN: 1444-1586; 1447-0594; 1447-0594
• DOI: 10.1111/ggi.14985

Aim Although the use of benzodiazepine receptor agonists is a risk factor for falls and fractures, whether benzodiazepine‐avoiding hypnotic bundles are beneficial in clinical settings remains unclear. Methods A new hospital‐wide standardized hypnotic bundle for insomnia, with suvorexant as the first choice, was created for clinical purposes. This single‐center retrospective cohort study involved a pre‐post design and adult inpatients who had had falls. The primary outcome was the total fall rate in the pre‐post groups. Additionally, the level change in the fall‐rate trend for each month at standardization of the new hypnotic bundle was analyzed. The numbers of hypnotic‐related falls and injuries requiring treatment were evaluated. Results There were no differences in baseline characteristics between the two groups, except for patients with COVID‐19. Overall, 31 736 patients were included in this study. The total number of falls was 924 (3.42‰) in the pre‐standardization group and 837 (3.31‰) in the post‐standardization group, with no significant difference. An interrupted time‐series analysis of the level change in the fall rate revealed that the gap in trend at standardization was –11%, with no significance. Hypnotic‐related falls were 300 (1.11‰) versus 213 (0.84‰), and the injury incidences were 251 (0.93‰) versus 181 (0.71‰) in the pre and post groups, respectively, showing a significant reduction. Conclusions The standardization of the new hypnotic bundle for insomnia did not help achieve a significant reduction in total falls. However, our findings suggest that this bundle has the potential to reduce hypnotic‐related falls and injuries in inpatients who have had falls. Geriatr Gerontol Int 2024; 24: 1144–1149. The standardization of new hypnotic bundles for insomnia did not reach statistical significance regarding a reduction in total falls. This bundle has the potential to reduce hypnotic‐related falls and injuries in inpatients who have fallen.