- •What is the primary question addressed by this study?
Following years of initiatives to reduce potentially inappropriate antipsychotic use in nursing homes, are there differences in the initiation of trazodone among newly admitted residents over time?
- •What is the main finding of this study?
Relative to those admitted in 2014 (a period associated with and leading up to several antipsychotic reduction efforts in Ontario, Canada), residents admitted prior (2010–2013) were more likely to be initiated on an antipsychotic, while residents admitted after (2015–2018) were less likely to be initiated on an antipsychotic.
Residents with dementia showed greater changes in medication initiation by year of admission, such that those admitted in the later period were more likely to be initiated on trazodone and less likely to be initiated on an antipsychotic compared to residents with dementia admitted in 2014.
- •What is the meaning of the finding?
Following efforts to reduce potentially inappropriate antipsychotic use in nursing homes, this study suggests a potential change to prescribing behavior over time, with trazodone possibly being initiated in lieu of antipsychotics for dementia symptoms.
To investigate whether trazodone is being initiated in lieu of antipsychotics following antipsychotic reduction efforts, this study described changes in medication initiation over time.
We conducted a retrospective cohort study of new admissions to nursing homes in Ontario, Canada between April 2010 and December 2019 using health administrative data (N = 61,068). The initiation of antipsychotic and trazodone use was compared by year of admission using discrete time survival analysis and stratified by history of dementia.
Relative to residents admitted in 2014, antipsychotic initiation significantly decreased in later years (e.g., 2017 admission year hazard odds ratio [HOR2017]=0.72 [95% confidence interval (95%CI)=0.62–0.82]) while trazodone initiation modestly increased (e.g., HOR2017=1.09 [95%CI=0.98–1.21]). The relative increase in trazodone initiation was larger among residents with dementia (e.g., HOR2017Dem =1.22 [95%CI=1.07–1.39]).
Differences in which medications were started following nursing home admission were observed and suggest trazodone may be initiated in lieu of antipsychotics.
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- Public reporting of antipsychotic prescribing in nursing homes: population-based interrupted time series analyses.BMJ Qual Saf. 2019; 28: 121-131
- Association of the Centers for Medicare & Medicaid Services' National Partnership to Improve Dementia Care with the use of antipsychotics and other psychotropics in long-term care in the United States from 2009 to 2014.JAMA Intern Med. 2018; 178: 640-647
- Changing pattern of sedative use in older adults: a population-based cohort study.Drugs Aging. 2016; 33: 523-533
- Potential unintended consequences of antipsychotic reduction in Ontario nursing homes.J Am Med Dir Assoc. 2022; 23: 1066-1072.e7
- Antidepressants for agitation and psychosis in dementia.Cochr Databf Syst Rev. 2011; CD008191https://doi.org/10.1002/14651858.CD008191.pub2
- Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study.CMAJ. 2018; 190: E1376-E1383
- Perceptions vs. evidence: therapeutic substitutes for antipsychotics in patients with dementia in long-term care.Aging Ment Health. 2018; 22: 544-549
- Variation and correlation of potential unintended consequences of antipsychotic reduction in Ontario nursing homes over time.Med Care. 2023; 61: 173-181
- New antidepressant use in older adults: a Canadian population-based study (1997-2013).Aging Mental Health. 2017; 21: 720-729
- Stakeholders' views on the use of psychotropic medication in older people: a systematic review.Age Ageing. 2022; 51afac060https://doi.org/10.1093/ageing/afac060
- Sequential drug treatment algorithm for agitation and aggression in Alzheimer's and mixed dementia.J Psychopharmacol. 2018; 32: 509-523
Published online: February 01, 2023
Accepted: January 27, 2023
Received in revised form: January 27, 2023
Received: October 28, 2022
Publication stageIn Press Journal Pre-Proof
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