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Changes in the initiation of antipsychotics and trazodone over time: a cohort study of new admissions to nursing homes in Ontario, Canada


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., HOR2017Dem =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.



Daniel A. Harris, Laura C. Maclagan, Priscila Pequeno, Andrea Iaboni, Peter C. Austin, Laura C. Rosella, Jun Guan, Colleen J. Maxwell, Susan E. Bronskill. Am J Geriatr Psychiatry. 2023; 31(6):449-55. Epub 2023 Feb 1.

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