Initiation of antidepressant medication after hip fracture in community-dwelling older adults

Objective — To evaluate the incidence, characteristics and correlates of antidepressant drug therapy initiation among community-dwelling older adults following hip fracture.

Design — Retrospective cohort study using linked, population-based administrative data

Setting — Province of Ontario, Canada

Participants — Older adults, age 65 years or older, with a hip fracture and hip fracture surgery between April 1, 2003 and February 28, 2011. The study sample was restricted to individuals who returned home following surgery and who had not been dispensed an antidepressant in the year prior to their fracture (n=25,436).

Measurements — The authors determined the incidence of new antidepressant use defined by the dispensing of antidepressant drug therapy within 90 days of discharge home. The authors identified independent correlates of antidepressant initiation using multivariate regression.

Results — Overall, antidepressants were newly initiated in 8.8% of older adults with hip fracture in the 90 days following hospital discharge. There was a statistically significant, 1.3 fold increase in incidence of antidepressant prescribing from 2003 to 2010. Trazodone, frequently prescribed at a low dose, accounted for 39.0% of newly dispensed antidepressants, followed by selective serotonin reuptake inhibitors (36.9%). Rehabilitation admission, psychiatric evaluation, a diagnosis of dementia, and baseline benzodiazepine use were the strongest independent correlates of antidepressant initiation.

Conclusions — The period after a hip fracture is associated with a high rate of initiation of antidepressant therapy. The data raise the possibility that antidepressants are frequently prescribed ‘off-label’ in these patients. Further research is needed to investigate the safety and efficacy of antidepressant use in this vulnerable population.