A comprehensive U.S. investigation indicates that older individuals admitted to hospitals with delirium might achieve more favorable results when managed with trazodone, a substance commonly prescribed for mood disorders and sleep disturbances, rather than the typically administered antipsychotic agents. Delirium, characterized by an abrupt onset of cognitive impairment often affecting the elderly during or following a hospital stay, is frequently addressed pharmacologically, notwithstanding the scarcity of data concerning the most secure therapeutic options.
The findings of this research, titled “Safety outcomes of trazodone versus antipsychotics for delirium after hospital admission in adults aged 65 years and older,” have been disseminated in The Lancet Healthy Longevity. Investigators meticulously examined extensive national health records pertaining to adults aged 65 and above who received medicinal interventions for delirium subsequent to hospital admission. A comparative analysis was conducted between patients administered trazodone and those prescribed atypical antipsychotic medications, including but not limited to quetiapine, risperidone, or olanzapine.
The data revealed that patients undergoing treatment with trazodone exhibited a diminished risk of mortality and were less prone to readmission compared to their counterparts receiving antipsychotic drugs. Crucially, the study did not identify any substantial discrepancies between the two cohorts regarding the incidence of falls or fractures – complications that represent a considerable concern for elderly patients utilizing sedative medications. These outcomes imply that trazodone could potentially serve as a more secure alternative to antipsychotic medications for the management of delirium in geriatric patients, particularly when pharmacological intervention is deemed indispensable.
To bolster the veracity of their conclusions, the research team employed a sophisticated analytical methodology known as target trial emulation, a technique designed to imbue real-world observational data with characteristics closely mirroring those of a randomized clinical trial. While the authors emphasize that pharmacotherapy should never supplant non-pharmacological strategies in delirium care, this study furnishes significant evidence to inform more judicious prescribing practices.
“The reduction in readmission rates observed among patients treated with trazodone might be attributable to a decrease in hospitalizations for delirium and urinary tract infections,” stated Dae Hyun Kim, MD, MPH, ScD, who holds the position of associate director and senior scientist at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research. “Conversely, earlier investigations have demonstrated that antipsychotic medications are associated with accelerated cognitive deterioration and can exert adverse effects on the urinary system, potentially escalating the likelihood of urinary retention, incontinence, and infections. While the potential for residual bias cannot be entirely discounted, these mechanisms could elucidate the observed correlation between antipsychotics and elevated risks of delirium and rehospitalization in our cohort.”
In addition to Dr. Kim, the research consortium included Chun-Ting Yang, PhD, a research fellow in medicine at Brigham and Women’s Hospital; James M. Wilkins, MD, DPhil, medical director of the Cognitive Neuropsychiatry Program at McLean Hospital; Kevin T. Pritchard, OT, PhD, OTR, a research fellow at the Marcus Institute, Hebrew SeniorLife; Qiaoxi Chen, a postdoctoral research fellow at Brigham and Women’s Hospital; Robert J. Glynn, ScD, PhD, ScD, a professor of medicine at Harvard Medical School and senior biostatistician at Brigham and Women’s Hospital; and Jerry Avorn, MD, a professor of medicine at Harvard Medical School, affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital.
