***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Fall-related injuries in older people are a leading cause of morbidity and mortality . Self-reported fall events in the last year is often used to estimate fall risk in older people . However , it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term . The objective of this study was to investigate if a history of one single non-injurious fall , at least two non-injurious falls , or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls . Methods Community-dwelling individuals 75–93 years of age ( n = 230 ) were initially followed prospect ively with monthly calendars reporting falls over a period of 12 months . The participants were classified into four groups based on the number and type of falls ( 0 , 1 , ≥2 non-injurious falls , and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department ) . The participants were then followed for several years ( mean time 5.0 years ±1.1 ) regarding injurious falls requiring a visit to the emergency department . The And ersen – Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls . Results During the long-term follow-up period , thirty per cent of the participants suffered from at least one injurious fall . Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term ( hazard ratio 2.78 ; 95 % CI , 1.40–5.50 ) compared to those with no falls . No other group showed an increased risk . Conclusions In community-dwelling people over 75 years of age , a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls . Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall Background Medication use is a potentially modifiable risk factor for falling ;  psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk . However , evidence is mainly based on studies that recorded falls retrospectively and /or did not determine medication use at the time of the fall . Therefore , we investigated the associations indicated in the literature between medication use and falls , using prospect ively recorded falls and medication use determined at the time of the fall . Methods Data from the B-PROOF ( B-vitamins for the prevention of osteoporotic fractures ) study were used , concerning community-dwelling elderly aged ≥65 years . We included 2,407 participants with pharmacy dispensing records . During the 2- to 3-year follow-up , participants recorded falls using a fall calendar . Cox proportional hazard models were applied , adjusting for potential confounders including age , sex , health status variables and concomitant medication use . Results During follow-up , 1,147 participants experienced at least one fall . Users of anti-arrhythmic medication had an increased fall risk ( hazard ratio [ HR ] 1.61 ; 95 % confidence interval [ CI ] 1.12–2.32 ) compared with non-users . Similarly , non-selective beta-blocker use was associated with an increased fall risk ( HR 1.41 [ 95 % CI 1.12–1.78 ] ) , while statin use was associated with a lower risk ( HR 0.81 [ 95 % CI 0.71–0.94 ] ) . Benzodiazepine use ( HR 1.32 [ 95 % CI 1.02–1.71 ] ) , and antidepressant use ( HR 1.40 [ 95 % CI 1.07–1.82 ] ) were associated with an increased fall risk . Use of other cardiovascular and psychotropic medication was not associated with fall risk . Conclusion Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics , non-selective beta-blockers , benzodiazepines , and antidepressant medication . Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients OBJECTIVES To determine whether benzodiazepine use in older women increased the risk of decline in physical function . DESIGN A four-year prospect i ve cohort study . SETTING The communities of Iowa and Washington counties , Iowa . PARTICIPANTS Eight hundred eighty-five women aged 70 and older who had completed physical performance tests in 1988 and 1992 . MEASUREMENTS Benzodiazepine use was determined during in-home interviews and classified by dose , duration , indication for use , and half-life . Physical performance tests included an assessment of st and ing balance , walking speed ( 8-foot distance ) , and repeated chair raises . RESULTS Ninety ( 10.2 % ) reported benzodiazepine use at baseline . After adjustment for baseline physical performance score and potential confounders , benzodiazepine use was associated with a greater decline in physical performance over 4 years than nonuse ( beta=-1.16 ; st and ard error (SE)=0.25 ; P<.001 ) . The use of higher-than-recommended dose was related to decline ( beta=-2.26 ; SE=0.47 ; P<.001 ) , and use of lower doses was not ( beta=-0.53 ; SE=0.46 ; P=.246 ) . Long-term use ( > or=3 years ) was related to decline ( beta=-1.65 ; SE=0.34 ; P<.001 ) , whereas recent and past use were not . Similar results were obtained when restricting the sample to those without disability at baseline . CONCLUSION This study provides evidence that older women who used benzodiazepines  were at risk for decline in physical performance . Subgroup analyses indicated that risk was greater with use of higher-than-recommended doses or for long duration ( > or=3 years ) . These findings highlight the importance of using benzodiazepines at the lowest effective dose for a limited duration in older women Background Explicit criteria for determining potentially inappropriate medication consumption in elderly were elaborated by Beers et al. These lists have been used worldwide to evaluate medical prescriptions but there is little epidemiologic evidence demonstrating negative consequences of inappropriate medication use . It has been reported that some drugs could increase the risk of falls , which are a frequent and serious problem in elderly population . We aim ed to evaluate the association between the use of potentially inappropriate medications and the risk of falls . Methods The 3C Study is a multicentre prospect i ve cohort study conducted in France with 4 years of follow-up . Non-institutionalized men and women aged 65 years or over ( N = 6343 ) were r and omly selected from electoral rolls . Data on socio-demographic , medical characteristics and medication use ( based on self-reports and data from the national healthcare insurance ) were collected . Use of inappropriate medication for elderly was defined from established criteria . Data about falls were collected at the two follow-up examinations ( 2 years and 4 years after baseline ) . The association between the exposure to inappropriate medications and the risk of falls was evaluated using multivariate models ( Cox model and logistic regression ) . Results 32 % of subjects reported inappropriate medication use at baseline and 29 % at least two of the three examinations ; 22 % had fallen 2 times or more during follow-up . Overall , inappropriate medication users had an increased risk of falling . This increase was mainly due to the use of long-acting benzodiazepines ( adjusted odds ratio ( OR ) = 1.4 , 95 % confidence interval : [ 1.1–1.8 ] , in both occasional and regular users ) , other inappropriate psychotropics ( adjusted OR = 1.7 [ 1.7–2.7 ] in regular users ) , or medication with anticholinergic properties ( adjusted OR = 1.6 [ 1.2–2.1 ] in regular users ) . Neither occasional , nor regular use of short- or intermediate-acting benzodiazepines was associated with an increased risk of falling . Further analysis in long-acting benzodiazepines users did not show any dose-effect relation between the number of prescriptions filled over a 3-year period and the risk of falling . Conclusion Our study showed that use of inappropriate medications was associated with an increased risk of falling in elderly persons . This increase was mainly due to long-acting benzodiazepines and other inappropriate psychotropics , and to medications with anticholinergic properties BACKGROUND Predisposing factors alone explain only a limited proportion of the variation in fall events , especially in people with dementia . The aim of this study was to identify precipitating factors for falls among people with dementia . METHODS We examined prospect i ve fall registration s over a two-year period on a psychogeriatric hospital ward in the north of Sweden . Circumstances associated with each fall event were analyzed by independent review ers , possible precipitating factors were documented , evaluated and the most likely precipitating factors were identified . In total , 223 patients with any type of diagnosed dementia were admitted to the ward and 91 fell at least once . Of these , 46 were women and 45 were men ( mean age 80.3 years , range 60 - 94 ) . RESULTS A total of 298 falls were registered , 62 % of which were sustained by men . The most likely factor or combination of factors could be ascertained in 247 falls ( 83 % ) . Falls took place at all hours but almost half of the falls ( 44 % ) occurred during the nightshift ( between 9 pm and 7 am ) . Acute disease or symptoms of disease and /or acute drug side-effects were , alone or in combination with other factors , judged to precipitate more than three out of four falls . CONCLUSION It is possible to identify many precipitating factors that may contribute to a fall . Falls in people with dementia should be regarded as a symptom of acute disease or as a drug side-effect until proven otherwise . Prompt detection of these relevant factors is , therefore , essential A r and omized , controlled , crossover clinical study compared 14-night treatment with 15 mg temazepam , 50 mg diphenhydramine , and placebo in elderly individuals with insomnia ( mean age , 73.9 years ; range , 70 - 89 years ) . Primary outcome measures were subjective assessment s of sleep recorded on sleep diaries . Secondary measures were the morning-after psychomotor impairment , using the digit symbol substitution task and the manual tracking task , and the morning-after memory impairment , using a free-recall procedure . Results showed sleep improvements with 15 mg temazepam compared with  placebo-sleep quality ( mean score , 3.3 ± 0.9 vs 2.9 ± 0.8 ; P = 0.03 ) , total sleep time ( 6.9 ± 1.0 hours vs 6.3 ±1.3 hours ; P = 0.02 ) , number of awakenings ( 1.5 ± 1.3 vs 2.0 ± 1.2 ; P < 0.001 ) , and sleep-onset latency ( 25 ± 22 minutes vs 37 ± 25 minutes ; P = 0.03 ) . Improvements were seen with diphenhydramine treatment compared with placebo on the number of awakenings only ( mean , 1.7 ± 1.1 vs 2.0 ± 1.2 ; P < 0.05 ) . Numbers of adverse events reported were similar after all treatments , although there was 1 fall during temazepam treatment . Findings indicate that temazepam is more effective  than diphenhydramine when compared with placebo at the doses tested , although this advantage is mitigated by the risk of falls associated with temazepam use . The choice of agent to use in the elderly must consider these relative benefits and risks BACKGROUND polypharmacy is an important risk factor for falls , but recent studies suggest only when including medications associated with increasing the risk of falls . DESIGN a prospect i ve , population -based cohort study . SUBJECTS 6,666 adults aged ≥50 years from The Irish Longitudinal study on Ageing . METHODS participants reported regular medication use at baseline . Any subsequent falls , any injurious falls and the number of falls were reported 2 years later . The association between polypharmacy ( > 4 medications ) or fall risk-increasing medications and subsequent falls or injurious falls was assessed using modified Poisson regression . The association with the number of falls was assessed using negative binomial regression . RESULTS during follow-up , 231 falls per 1,000 person-years were reported . Polypharmacy including antidepressants was associated with a greater risk of any fall ( adjusted relative risk ( aRR ) 1.28 , 95 % CI 1.06 - 1.54 ) , of injurious falls ( aRR 1.51 , 95 % CI 1.10 - 2.07 ) and a greater number of falls ( adjusted incident rate ratio ( aIRR ) 1.60 , 95 % CI 1.19 - 2.15 ) , but antidepressant use without polypharmacy and polypharmacy without antidepressants were not . The use of benzodiazepines was associated with injurious falls when coupled with polypharmacy ( aRR 1.40 , 95 % CI 1.04 - 1.87 ) , but was associated with a greater number of falls ( aIRR 1.32 , 95 % CI 1.05 - 1.65 ) , independent of polypharmacy . Other medications assessed , including antihypertensives , diuretics and anti 
    Output:
    
Exposure to BZDs was associated with a higher risk of falls  in older adults , which is consistent with the results reported in the literature and previous review s and meta-analyses .
BZDs increase the risk of falling when used either as monotherapy or in combined therapies .
It is preferable to use short-acting BZDs , to avoid cumulative effects over time predisposing to falls .
A high proportion of falls in older adults are related to the use of BZDs .