{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T19:00:05Z","timestamp":1781809205560,"version":"3.54.5"},"reference-count":35,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2019,11,21]],"date-time":"2019-11-21T00:00:00Z","timestamp":1574294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shanghai Municipal Commission of Health and Family Planning","award":["201640040"],"award-info":[{"award-number":["201640040"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Falls are leading cause of injury among older people, especially for those living in long-term care facilities (LTCFs). Very few studies have assessed the effect of sleep quality and hypnotics use on falls, especially in Chinese LTCFs. The study aimed to examine the association between sleep quality, hypnotics use, and falls in institutionalized older people. Methods: We recruited 605 residents from 25 LTCFs in central Shanghai and conducted a baseline survey for sleep quality and hypnotics use, as well as a one-year follow-up survey for falls and injurious falls. Logistic regression models were applied in univariate and multivariate analysis. Results: Among the 605 participants (70.41% women, mean age 84.33 \u00b1 6.90 years), the one-year incidence of falls and injurious falls was 21.82% and 15.21%, respectively. Insomnia (19.83%) and hypnotics use (14.21%) were prevalent. After adjusting for potential confounders, we found that insomnia was significantly associated with an increased risk of falls (adjusted risk ratio (RR): 1.787, 95% CI, 1.106\u20132.877) and the use of benzodiazepines significantly increased the risk of injurious falls (RR: 3.128, 95% CI, 1.541\u20136.350). Conclusion: In elderly LTCF residents, both insomnia and benzodiazepine use are associated with an increased risk of falls and injuries. Adopting non-pharmacological approaches to improve sleep quality, taking safer hypnotics, or strengthening supervision on benzodiazepine users may be useful in fall prevention.<\/jats:p>","DOI":"10.3390\/ijerph16234623","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T02:49:27Z","timestamp":1574390967000},"page":"4623","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities"],"prefix":"10.3390","volume":"16","author":[{"given":"Yu","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"},{"name":"Changning District Centre for Disease Control and Prevention, Shanghai 200052, China"},{"name":"Key Lab of Health Technology Assessment, National Health Commission of the People\u2019s Republic of China (Fudan University), Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghua","family":"Xia","sequence":"additional","affiliation":[{"name":"Changning District Centre for Disease Control and Prevention, Shanghai 200052, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Wang","sequence":"additional","affiliation":[{"name":"Changning District Centre for Disease Control and Prevention, Shanghai 200052, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Changning District Centre for Disease Control and Prevention, Shanghai 200052, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Jiang","sequence":"additional","affiliation":[{"name":"Changning District Centre for Disease Control and Prevention, Shanghai 200052, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinod K.","family":"Diwan","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences (Global Health\/IHCAR), Karolinska Institute, 17177 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"},{"name":"Key Lab of Health Technology Assessment, National Health Commission of the People\u2019s Republic of China (Fudan University), Shanghai 200032, China"},{"name":"Department of Public Health Sciences (Global Health\/IHCAR), Karolinska Institute, 17177 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S0749-0690(02)00002-2","article-title":"The epidemiology of falls and syncope","volume":"18","author":"Rubenstein","year":"2002","journal-title":"Clin. Geriatr. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1177\/0898264316641083","article-title":"Factors Associated with Injurious Falls in Residential Care Facilities","volume":"29","author":"Towne","year":"2017","journal-title":"J. Aging Health"},{"key":"ref_3","first-page":"2883","article-title":"Analysis on status quo of falls of the elderly in pension institutions","volume":"12","author":"Ding","year":"2014","journal-title":"Chin. Gen. Pract. Nurs."},{"key":"ref_4","first-page":"654","article-title":"Analysis of epidemic features and risk factors of the elderly falls among nursing home residents","volume":"25","author":"Zhao","year":"2016","journal-title":"Chin. J. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/0164027514537081","article-title":"Factors associated with daytime sleep in nursing home residents","volume":"37","author":"Li","year":"2015","journal-title":"Res. Aging."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jsmc.2017.09.011","article-title":"Sleep and Long-Term Care","volume":"13","author":"Ye","year":"2018","journal-title":"Sleep Med. Clin."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/1054773816673175","article-title":"Sleep Among Long-Term Care Residents in China: A Narrative Review of Literature","volume":"27","author":"Li","year":"2018","journal-title":"Clin. Nurs. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1111\/jgs.13099","article-title":"Insomnia in long-term care facilities: A comparison of seven European countries and Israel: The Services and Health for Elderly in Long TERm care study","volume":"62","author":"Gindin","year":"2014","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"17504","DOI":"10.1038\/s41598-018-36053-4","article-title":"Day-to-day variations in sleep quality affect standing balance in healthy adults","volume":"8","author":"Montesinos","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1159\/000442418","article-title":"Sleep Duration in Relation to Cognitive Function among Older Adults: A Systematic Review of Observational Studies","volume":"46","author":"Devore","year":"2016","journal-title":"Neuroepidemiology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1093\/sleep\/30.9.1105","article-title":"Nighttime Sleep, Chinese Afternoon Nap, and Mortality in the Elderly","volume":"30","author":"Lan","year":"2007","journal-title":"Sleep"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1177\/0733464816681149","article-title":"Poor Sleep and Risk of Falls in Community-Dwelling Older Adults: A Systematic Review","volume":"37","author":"Min","year":"2018","journal-title":"J. Appl. Gerontol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1001\/archinternmed.2009.357","article-title":"Meta-analysis of the impact of 9 medication classes on falls in elderly Persons","volume":"169","author":"Woolcott","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Donnelly, K., Bracchi, R., Hewitt, J., Routledge, P.A., and Carter, B. (2017). Benzodiazepines, Z-drugs and the risk of hip fracture: A systematic review and meta-analysis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0174730"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1111\/j.1532-5415.2005.53304.x","article-title":"Insomnia and Hypnotic Use, Recorded in the Minimum Data Set, as Predictors of Falls and Hip Fractures in Michigan Nursing Homes","volume":"53","author":"Avidan","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3685789","DOI":"10.1155\/2016\/3685789","article-title":"The Association between Sleep Problems, Sleep Medication Use, and Falls in Community-Dwelling Older Adults: Results from the Health and Retirement Study 2010","volume":"2016","author":"Min","year":"2016","journal-title":"J. Aging Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1111\/j.1532-5415.2005.53455.x","article-title":"Development of a common outcome data set for fall injury prevention trials: The prevention of falls network Europe consensus","volume":"53","author":"Lamb","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0022-3999(00)00095-7","article-title":"Athens insomnia scale: Validation of an instrument based on ICD-10 criteria","volume":"48","author":"Soldatos","year":"2000","journal-title":"J. Psychosom. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"Mini-mental state: A practical method for grading the cognitive status of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/0022-3956(82)90033-4","article-title":"Development and validation of a geriatric depression screening scale: A preliminary report","volume":"17","author":"Yesavage","year":"1982","journal-title":"J. Psychiatr. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12877-018-0803-6","article-title":"Evaluation of the reliability and validity for X16 balance testing scale for the elderly","volume":"18","author":"Ju","year":"2018","journal-title":"BMC Geriatr."},{"key":"ref_22","first-page":"S131","article-title":"Comorbidity indices","volume":"32","author":"Dougados","year":"2014","journal-title":"Clin. Epidemiol. Biostat."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1001\/jamainternmed.2013.3801","article-title":"What\u2032s to blame for falls and fractures? Poor sleep or the sleeping medication?: Comment on \"Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents\"","volume":"173","author":"Widera","year":"2013","journal-title":"JAMA Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Essien, S.K., Feng, X., Sun, W.J., Farag, M., Li, L.H., and Gao, Y.Q. (2018). Sleep duration and sleep disturbances in association with falls among the middleaged and older adults in China: A population-based nationwide study. BMC Geriatr., 18.","DOI":"10.1186\/s12877-018-0889-x"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1093\/gerona\/62.1.62","article-title":"Sleep Disturbances and Falls in Older People","volume":"62","author":"Latimer","year":"2007","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.3349\/ymj.2017.58.6.1222","article-title":"Association between Sleep Duration and Injury from Falling among Older Adults: A Cross-Sectional Analysis of Korean Community Health Survey Data","volume":"58","author":"Noh","year":"2017","journal-title":"Yonsei Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/j.1365-2869.2010.00867.x","article-title":"Self-reported sleep duration and falls in older adults","volume":"20","author":"Mesas","year":"2011","journal-title":"J. Sleep Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1001\/archinte.168.16.1768","article-title":"Actigraphy-Measured Sleep Characteristics and Risk of Falls in Older Women","volume":"168","author":"Stone","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1097\/JCP.0b013e31817d5943","article-title":"Fracture risk from psychotropic medications: A population-based analysis","volume":"28","author":"Bolton","year":"2008","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"825","DOI":"10.2165\/00023210-200317110-00004","article-title":"Benzodiazepines and risk of hip fractures in older people: A review of the evidence","volume":"17","author":"Cumming","year":"2003","journal-title":"CNS Drugs"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2296-10-1","article-title":"Association between risk factors for injurious falls and new benzodiazepine prescribing in elderly persons","volume":"10","author":"Bartlett","year":"2009","journal-title":"BMC Fam. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"219","DOI":"10.3961\/jpmph.2012.45.4.219","article-title":"Zolpidem Use and Risk of Fracture in Elderly Insomnia Patients","volume":"45","author":"Kang","year":"2012","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1016\/S1389-9457(08)70012-1","article-title":"Sleep, insomnia and falls in elderly patients","volume":"9","author":"Stone","year":"2008","journal-title":"Sleep Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/j.jpainsymman.2010.07.021","article-title":"Validation of the Taiwanese version of the Athens Insomnia Scale and assessment of insomnia in Taiwanese cancer patients","volume":"41","author":"Sun","year":"2011","journal-title":"J. Pain Symptom Manag."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/JGP.0b013e318252e3e0","article-title":"Sleep disturbance among older adults in assisted living facilities","volume":"20","author":"Fung","year":"2012","journal-title":"Am. J. Geriatr. Psychiatry"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/23\/4623\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:36:18Z","timestamp":1760189778000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/23\/4623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,21]]},"references-count":35,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["ijerph16234623"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16234623","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,21]]}}}