Examining the Association Between Z-Drug Usage and Falls in Hospice Patients

Insomnia, characterized by difficulty maintaining or initiating sleep, is increasingly common in older individuals, including at the very end of life. When hospice patients experience insomnia, it can be very distressing to them as well as to their caregivers. It is often treated with pharmacological interventions that include a class of non-benzodiazepine sedative-hypnotic central-nervous system acting medications known as z-drugs. Z-drugs are popular for their promotion of natural sleep patterns, but they can also pose risks, as their use has been associated with increased risk of falls and fractures. In order to better understand the possible role of z-drug usage in falls, a retrospective study was conducted examining the medication records, daily care narratives, and incident reports of a population of 62 hospice patients who had a record of 1 or more falls while receiving care at a residential care home. The records were examined to determine whether z-drugs had been administered within the 24 hours preceding each fall, and, if so, the specific z-drug and dosage that was administered. It was hypothesized that a substantial proportion of fall incidents would be preceded by z-drug administration, suggesting an association between z-drug usage and increased fall risk in hospice patients. Additionally, pre-admission sleep medication usage was assessed to offer additional context on z-drug usage patterns. The findings of this study hope to contribute to a deeper understanding of the fall risks associated with z-drugs among patients at the very end of life.