Trazodone Shows Promise as Safer Choice to Antipsychotics for hospitalized Older Adults with Delirium
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A new study suggests trazodone, a common medication for depression and sleep, may improve outcomes for older adults experiencing delirium during or after hospitalization, offering a possibly safer alternative to traditional antipsychotic treatments.
Older adults hospitalized with delirium, a sudden state of confusion, are often treated with medication, but evidence supporting the safest options has been limited. Now, research published in The Lancet Healthy Longevity indicates that trazodone may reduce the risk of death and rehospitalization compared to antipsychotic drugs like quetiapine, risperidone, and olanzapine.
Lower Risk of Death and Rehospitalization with Trazodone
Researchers analyzed nationwide health data from individuals aged 65 and older who were prescribed medication for delirium following hospital admission. The analysis revealed a significant benefit for those treated with trazodone. Patients in this group experienced a lower risk of mortality and were less likely to require readmission to the hospital than those receiving antipsychotics.
Notably, the study found no significant difference between the two groups regarding rates of falls or fractures – critical concerns when prescribing sedating medications to older populations.This suggests trazodone may offer a more favorable safety profile.
Advanced Analysis Strengthens Findings
To bolster the reliability of their findings,the research team employed a elegant analytical technique called target trial emulation. This method aims to mimic the conditions of a randomized controlled trial using real-world observational data. While acknowledging that medication should complement, not replace, non-pharmacological approaches to delirium care, the study provides crucial evidence for informed prescribing decisions.
“The lower risk of rehospitalization among patients treated with trazodone may be related to fewer hospital admissions for delirium and urinary tract infections,” explained a senior scientist at Hebrew seniorlife’s Hinda and Arthur Marcus Institute for Aging Research. “Prior research demonstrates that antipsychotic medications can contribute to cognitive decline and negatively impact the urinary system,potentially increasing the risk of retention,incontinence,and infections. These effects may explain the higher risks of delirium and rehospitalization observed with antipsychotics in our study, though the possibility of residual bias cannot be excluded.”
Implications for Clinical Practice
The findings have significant implications for how delirium is managed in hospitals. Antipsychotics have long been a standard treatment, but their potential side effects – including cognitive impairment and urinary issues – are particularly concerning for vulnerable older adults.Trazodone, with it’s more benign side effect profile in this context, could represent a valuable alternative.
The research team included experts from Brigham and Women’s Hospital, McLean Hospital, Harvard Medical School, and Hebrew SeniorLife. The study was based on
Answers to Questions (integrated into the article):
* Why: The study investigated whether trazodone could be a safer alternative to antipsychotics for treating delirium in older hospitalized patients.
* who: Researchers from Brigham and Women’s Hospital, McLean Hospital, Harvard Medical School, and Hebrew SeniorLife conducted the study, analyzing data from individuals aged 65 and older.
* What: The study found that trazodone was associated with a lower risk of death and rehospitalization compared to antipsychotic drugs in older adults with delirium. It also found no significant difference in fall or fracture rates.
* How did it end?: The study concluded that trazodone might potentially be a valuable alternative to antipsychotics for managing delirium in older adults, potentially improving outcomes and reducing harmful side
