Abstract
The purpose of this study was to examine the effects of non-benzodiazepine hypnotics, orexin receptor antagonists, and melatonin receptor agonists on both the incidence and timing of falls among older adults. Fall incident reports collected over a two-year period beginning in January 2021 at an acute care hospital were reviewed to identify patients aged 65 years or older without psychiatric disorders. The study population included 60 patients prescribed either the non-benzodiazepine hypnotic eszopiclone (Lunesta® 1 mg), the orexin receptor antagonist lemborexant (Dayvigo® 5 mg), or the melatonin receptor agonist ramelteon (Rozerem® 8 mg), together with 295 patients who had not received hypnotics, yielding a total of 355 patients. Baseline characteristics, fall incidence, and timing of falls were compared across groups. Fall incidence was 11.4% in the ramelteon group, 4.8% in the lemborexant group, and 3.5% in the eszopiclone group, with the rate in the ramelteon group significantly higher than in the other groups (p = 0.018, R = 2.8). The eszopiclone group had the lowest incidence, suggesting that non-benzodiazepine hypnotics may be relatively safe with respect to falls. Regarding the timing of falls, significant differences compared with the control group were observed in the eszopiclone group (p = 0.017) and the lemborexant group (p = 0.001). In the eszopiclone group, falls occurred more frequently around midnight (R = 2.1) and less frequently in the afternoon (R = −2.3), whereas in the lemborexant group, falls were less frequent around midnight (R = −2.5) and more frequent in the afternoon (R = 3.0). These findings suggest that when prescribing hypnotics to older adults, it is important to consider not only the overall risk of falls but also the timing of falls associated with each agent, in order to implement appropriate fall-prevention strategies.
