2026 Southeastern Residency Conference

Title: Falling into Z-drugs: An Analysis of Z-drug Use and Fall Risk in Older Adults 
Authors: Madelyn Singleton, Laura Schalliol, Kelsee Tignor, Taylor Dabney 
 
Purpose: 
This study evaluates the association between Z-drug use and fall risk, evidenced by STEADI Fall Risk Assessment scores (≥4 indicating elevated risk). Z-drugs, including zolpidem (Ambien®, Edluar®), eszopiclone (Lunesta®), and zaleplon, are listed as potentially inappropriate medications in the 2023 Beers Criteria. Findings will help clarify their impact on fall risk and improve prescribing and medication safety in older adults. 
 
Methods: 
This study is a single-center retrospective chart analysis including patients 65 or older who completed a Medicare Annual Wellness Visit (MAWV) between January 1 and October 31, 2025, with a STEADI Falls Risk Assessment and an active Z-drug prescription. The STEADI tool utilized is a 12-point questionnaire with scores of ≥4 indicating increased fall risk. Patients were excluded if they had dementia, received hospice or palliative care, or if they resided in a nursing home. 

From the de-identified patient list the following data points were collected: patient sex, age, weight, date of MAWV, STEADI Fall Risk Assessment Score, Z-drug prescribed including dose and start date, diagnosis of insomnia or a movement or neurological disorder, documented mobility issues or hearing impairment, care setting, number of medications at time of MAWV and medication list, and history of a fall documented at MAWV.  As applicable, a Z-drug end date and insomnia ICD-10 code were recorded. The primary outcome is to evaluate the association between STEADI fall risk scores and the use of Z-drugs. The secondary outcome is to evaluate the association between polypharmacy, defined as ≥5 active medications, and STEADI fall risk scores. Collected data will undergo descriptive statistical analysis. 
 
Results: 
Of 78 patients screened, 67 patients were included in the analysis. The average age of the study population was 73 years old and the average STEADI score was 2.3. The most prescribed Z-drug was zolpidem with 52 patients (75%) taking this medication. This study found that 13 patients (19.4%) demonstrated an increased fall risk as shown through the STEADI score with a Z-drug prescription.  Additionally, 12 patients (17.9%) were identified as having both an increased fall risk and experiencing polypharmacy.  
 
Conclusion: 
In conclusion, the study findings suggest that within the study population there is not an association between Z-drug use and increased fall risk as evidenced by STEADI Fall Risk Assessment Scores of 4 or more.