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

IF 2.4 4区医学 Q3 GERIATRICS & GERONTOLOGY

Geriatrics & Gerontology International Pub Date : 2024-09-30 DOI:10.1111/ggi.14985

Yuta Yoshino, Naoko Fudaka, Yumiko Shibasaki, Miyuki Ogawa, Yoshimasa Watanabe

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引用次数: 0

Abstract

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.

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标准化催眠药束对住院期间失眠和降低跌倒率的影响：单中心回顾性队列研究。

目的：虽然使用苯并二氮杂卓受体激动剂是导致跌倒和骨折的风险因素之一，但避免使用苯并二氮杂卓的催眠药捆绑疗法在临床环境中是否有益仍不清楚：方法：为临床目的，在全院范围内创建了新的失眠症标准化催眠药束，并将舒眠宁作为首选。这项单中心回顾性队列研究采用了前-后设计，研究对象为发生过跌倒的成年住院患者。主要结果是前后组的总跌倒率。此外，还分析了新催眠药捆绑标准化后每月跌倒率趋势的水平变化。此外，还评估了与催眠药相关的跌倒和需要治疗的受伤人数：除 COVID-19 患者外，两组患者的基线特征无差异。本研究共纳入 31 736 名患者。标准化前组的跌倒总次数为 924 次（3.42‰），标准化后组的跌倒总次数为 837 次（3.31‰），差异无显著性。对跌倒率水平变化的间断时间序列分析显示，标准化时的趋势差距为-11%，差异不显著。催眠药相关跌倒率为 300（1.11‰）对 213（0.84‰），受伤发生率为 251（0.93‰）对 181（0.71‰），前后两组分别有显著下降：针对失眠症的新催眠药束的标准化无助于显著减少跌倒总数。然而，我们的研究结果表明，这种捆绑疗法有可能减少曾发生过跌倒的住院病人因催眠药导致的跌倒和伤害。Geriatr Gerontol Int 2024; --：-----.

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来源期刊

Geriatrics & Gerontology International 医学-老年医学

CiteScore

5.50

自引率

6.10%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Geriatrics & Gerontology International is the official Journal of the Japan Geriatrics Society, reflecting the growing importance of the subject area in developed economies and their particular significance to a country like Japan with a large aging population. Geriatrics & Gerontology International is now an international publication with contributions from around the world and published four times per year.