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

Daniel A Harris; Laura C Maclagan; Priscila Pequeno; Andrea Iaboni; Peter C Austin; Laura C Rosella; Jun Guan; Colleen J Maxwell; Susan E Bronskill

doi:10.1016/j.jagp.2023.01.022

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

Am J Geriatr Psychiatry. 2023 Jun;31(6):449-455. doi: 10.1016/j.jagp.2023.01.022. Epub 2023 Feb 3.

Authors

Daniel A Harris¹, Laura C Maclagan², Priscila Pequeno², Andrea Iaboni³, Peter C Austin⁴, Laura C Rosella⁵, Jun Guan², Colleen J Maxwell⁶, Susan E Bronskill⁷

Affiliations

¹ Division of Epidemiology, Dalla Lana School of Public Health (DAH, LCR, SEB), University of Toronto, Toronto, ON, Canada. Electronic address: daniel.harris@mail.utoronto.ca.
² ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada.
³ KITE Research Institute-Toronto Rehabilitation Institute (AI), University Health Network, Toronto, ON, Canada; Department of Psychiatry (AI), University of Toronto, Toronto, ON, Canada.
⁴ ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada; Sunnybrook Research Institute (PCA, SEB), Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (PCA, SEB), University of Toronto, Toronto, ON, Canada.
⁵ Division of Epidemiology, Dalla Lana School of Public Health (DAH, LCR, SEB), University of Toronto, Toronto, ON, Canada; ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada; Institute for Better Health, Trillium Health Partners (LCR) , Mississauga, ON, Canada; Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine (LCR), University of Toronto, Toronto, ON, Canada; Vector Institute (LCR), Toronto, ON, Canada.
⁶ ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada; Schools of Pharmacy and Public Health Sciences, University of Waterloo (CJM), Waterloo, ON, Canada.
⁷ Division of Epidemiology, Dalla Lana School of Public Health (DAH, LCR, SEB), University of Toronto, Toronto, ON, Canada; ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada; Sunnybrook Research Institute (PCA, SEB), Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (PCA, SEB), University of Toronto, Toronto, ON, Canada; Women's College Research Institute (SEB), Women's College Hospital, Toronto, ON, Canada.

PMID: 36842890
DOI: 10.1016/j.jagp.2023.01.022

Abstract

Objectives: To investigate whether trazodone is being initiated in lieu of antipsychotics following antipsychotic reduction efforts, this study described changes in medication initiation over time.

Methods: 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.

Results: 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., HOR_2017Dem =1.22 [95%CI=1.07-1.39]).

Conclusions: Differences in which medications were started following nursing home admission were observed and suggest trazodone may be initiated in lieu of antipsychotics.

Keywords: Antipsychotics; Ontario; dementia; medication substitution; nursing homes; trazodone.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antipsychotic Agents* / therapeutic use
Cohort Studies
Dementia* / drug therapy
Dementia* / epidemiology
Humans
Nursing Homes
Ontario / epidemiology
Retrospective Studies
Trazodone*

Substances

Antipsychotic Agents
Trazodone