![]() 18Ĭiting little benefit for improved sleep latency and duration, the American Geriatrics Society Beers Criteria advises to avoid the use of non-BZD hypnotics, with their most recent update removing the caveat for chronic 90-day use and discouraging use of any duration. In both instances, zolpidem accounted for significantly more emergency department visits than any other psychotropic medication. 13- 17 Notably, in a study examining emergency department visits involving adverse events related to psychiatric medications, zolpidem was implicated in 11.5% of all adult psychiatric medication adverse event emergency department visits and in 21.0% of visits involving older adults. 11, 12 Adverse events associated with non-BZD hypnotics are well documented and include dizziness, drowsiness, falls, fracture, cognitive impairment, delirium, parasomnias, motor vehicle accidents, and mortality. 9, 10Īlthough historically considered safer than BZDs, non-BZD hypnotics are high-risk medications nonetheless, and their use by older adults should be avoided. One study using data from the National Ambulatory Medical Care Survey reported that non-BZD hypnotic prescribing increased 350% from 1999 to 2010-the same time period that BZD use plateaued. 2- 8 Combined with a rising trend in the diagnosis and treatment of insomnia, non-BZD hypnotics have filled this prescribing void and are now among the most widely prescribed medications in adults. 1 Traditionally, BZDs were the preferred medical treatment for insomnia but have fallen out of favor in recent years because of concerns regarding abuse and addiction potential. Compared with BZDs, non-BZD hypnotics exhibit greater specificity for omega 1 γ-aminobutyric acid (GABA) receptors, which are responsible for sedation. Nonbenzodiazepine (non-BZD) hypnotics are indicated for the treatment of insomnia and include the agents zolpidem, eszopiclone, and zaleplon. Study findings provide additional rationale for reducing the prescribing of high-risk medications for older adults. Pneumonia is an adverse event of significant clinical concern in older adults but has not been specifically evaluated for non-BZD hypnotics. This study evaluates the risk of pneumonia in a large population of older adults in an integrated health care system. The manuscript was primarily written by Jung, along with Spence and Escasa, and revised by Spence, Escasa, and Lee, along with the other authors. Jung, Spence, and Hui were responsible for data collection, and data interpretation was performed by Jung and Spence, with assistance from Escasa, Lee, and Hui. Study concept and design were contributed by Jung, Spence, Lee, and Gibbs. All authors are employed by Kaiser Permanente and report no other potential financial conflicts of interest. At the time of this study, Jung was a PGY2 resident in drug information at Kaiser Permanente Drug Information Services. ![]() The findings of this study provide additional support for reducing the use of non-BZD hypnotics in older adults and for pursuing safer alternatives for treating insomnia.ĭISCLOSURES: No outside funding supported this study. Short-term exposure was associated with a relatively higher risk of pneumonia (OR = 1.57 95% CI = 1.39-1.77) compared with long-term use (OR = 1.16 95% CI = 1.06-1.25).ĬONCLUSIONS: Current use of non-BZD hypnotics in older adults is associated with an increased risk of pneumonia. When exposure was stratified by proximity to index date, only current exposure was associated with an increased risk of pneumonia (OR = 1.27 95% CI = 1.18-1.36). Non-BZD hypnotic exposure was associated with an increased risk of pneumonia (OR = 1.14 95% CI = 1.08-1.20). Of the cases with pneumonia, 5.5% (2,790) of cases had exposure to a non-BZD hypnotic, compared with 3.4% (6,345) of controls. RESULTS: We identified 51,029 cases with pneumonia and matched 188,391 controls without pneumonia. Conditional logistic regression adjusted for covariates was performed. Proximity of exposure to index date and duration of use were analyzed. Non-BZD hypnotic exposure was evaluated for all cases and controls 1 year before the index date. Controls were matched in a 4:1 ratio to cases based on age, gender, and active enrollment. Cases were identified as patients aged 65 years and older with a diagnosis of pneumonia from January 2011 to December 2012. METHODS: This was a retrospective case-control study of members aged 65 years and older enrolled in an integrated health care system. OBJECTIVE: To evaluate the risk of pneumonia associated with non-BZD hypnotic use in the elderly. BACKGROUND: Previous studies have shown an increased risk of pneumonia with benzodiazepines (BZD) and an increased risk of any infection with non-BZD hypnotics, but no analysis has specifically investigated the risk of pneumonia with non-BZD hypnotic use.
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