New low-dose trazodone vs new low-dose benzodiazepine subgroupĭata extracted from Bronskill et al. See Table 1 for Results.įall-related ED visit or acute care hospitalization within 90 daysįall-related (with hip or wrist fracture diagnosis) ED visit or acute care hospitalization within 90 daysĬensoring on exposure drug discontinuation or switching The median dose of trazodone used was 50 mg/day (interquartile range 25-51.7 mg/day), whereas the median dose of benzodiazepines used was 1.07 mg/day lorazepam equivalents (interquartile range 0.75-2.14 mg/day). Propensity score matching produced 7,792 analytical pairs. Of the 169,595 patients assessed, new users of low-dose trazodone (n=9,650) and benzodiazepines (n=10,642) within 7 days before or after clinical assessment were identified. Propensity score matching was used to compare residents with similar baseline characteristics, including comorbidities, cognitive status, and fall risk. Residents were followed in an intent-to-treat fashion such that switching drug exposure groups and/or discontinuation were permitted, but the individuals remained in their initial groups. Secondary outcomes included a composite of fall-related ED visits or acute care hospitalizations with a hip or wrist fracture diagnosis within 90 days of exposure. The primary outcome was the first occurrence of a composite of fall-related emergency department (ED) visit or an acute care hospitalization within 90 days of exposure to either low-dose trazodone or benzodiazepines. The investigators identified nursing home residents who were newly initiated on low-dose trazodone (≤150 mg) or a benzodiazepine, defined as a lorazepam 2.5 mg per day dose or equivalent. Information on dispensed drug therapies were obtained from the Ontario Drug Benefit database. An assessment was excluded if no drugs were prescribed in the year before the assessment, if the resident was comatose or completely bedbound at the time of the assessment, or if the resident had received palliative care in the 180 days before the assessment. Assessments were performed using the Resident Assessment Instrument Minimum Data Set (RAI-MDS) version 2.0, a validated tool. The Continuing Resident Reporting System database identified 595,898 full medical assessments of 169,595 residents aged ≥ 66 years between April 1, 2010, and March 31, 2015. 4 This was a retrospective cohort study evaluating fall risk in nursing home residents in Ontario, Canada. 3Ī recent study compared the risk of falls associated with trazodone and benzodiazepine use. 2 The STOPP/START criteria recommends that benzodiazepines be discontinued in older adults who’ve experienced a fall within the past three months, have acute or chronic respiratory failure, or if used for longer than four weeks, regardless of indication. Benzodiazepine use may be considered if there is a compelling indication for their use, such as a seizure disorder or severe generalized anxiety disorder. 5,6,7 The American Geriatric Society recommends that benzodiazepines be avoided in the older adults since this population is more susceptible to cognitive impairment, delirium, falls, fractures, and motor vehicle crashes. It is widely known that the use of psychotropic drugs, such as antidepressants and antipsychotics, are associated with an increased risk of falls, particularly in nursing home residents. 2,3,4 Is trazodone really safer for patients than benzodiazepines? 1 Neither the Beers Criteria nor the STOPP/START Criteria mention trazodone as a potentially inappropriate medication for use in the older adults - perhaps due to a lack of studies demonstrating harm. Trazodone is increasingly prescribed instead of benzodiazepines for elderly nursing home residents. Medication therapy is often sought to treat and manage these diseases, but healthcare providers often overlook the risks of prescribing medications to patients who are older, frail, and at high risk for falls. Older adults are often tormented by insomnia, pain, and other comorbidities that impact their quality of life and overall health. Link Your browser does not support iframes, but you can use the following link. Your browser does not support iframes, but you can use the following link. Low-Dose Trazodone, Benzodiazepines, and Fall-Related Injuries in Nursing Homes: A Matched-Cohort Study. Bronskill SE, Campitelli MA, Iaboni A, Herrmann N, Guan J, Maclagan LC, Watt J, Rochon PA, Morris AM, Jeffs L, Bell CM, Maxwell CJ.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |