Changes in the Initiation of Antipsychotics and Trazodone Over Time: A Cohort Study of New Admissions to Nursing Homes in Ontario, Canada

• Published in: The American journal of geriatric psychiatry 2023-06, Vol.31 (6), p.449-455
• Main Authors: Harris, Daniel A., Maclagan, Laura C., Pequeno, Priscila, Iaboni, Andrea, Austin, Peter C., Rosella, Laura C., Guan, Jun, Maxwell, Colleen J., Bronskill, Susan E.
• Format: Article
• Language: English
• Subjects: Antipsychotic Agents - therapeutic use; Antipsychotics; Cohort Studies; dementia; Dementia - drug therapy; Dementia - epidemiology; Humans; medication substitution; Nursing Homes; Ontario; Ontario - epidemiology; Retrospective Studies; Trazodone
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2023.01.022

•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.