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Canada Study finds alternative to antipsychotic medication for seniors also has drawbacks

Doctors are prescribing the antidepressant trazodone more frequently to seniors with dementia in long-term care homes as a result of mounting concerns over antipsychotics.

But there are many unanswered questions about the safety of the drug in dementia patients and Canadian researchers set out to determine whether it is a safer alternative to antipsychotics.

Their study, published Monday in the Canadian Medical Association Journal, found seniors in long-term care who take trazodone face a heightened risk of falls and fractures. The risks are on par with the fall and fracture risk associated with antipsychotics, the research found.

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Lead author Jennifer Watt, a geriatrician at Toronto’s St. Michael’s Hospital, said the findings should send the message that trazodone isn’t necessarily a safer alternative to antipsychotics for dementia patients in long-term care.

“For a number of years, we knew antipsychotics were bad,” Dr. Watt said in an interview. “We didn’t know other drugs were just as bad."

Many seniors with dementia in long-term care are given antipsychotic drugs to manage agitation, aggression and other common symptoms of the disease. Despite this, there is little evidence to show these drugs are effective and there are fears over dangers such as an increased risk of heart attack, as well as falls and fractures. This has led many health professionals to call for non-drug-related treatments for the disease.

A number of studies published in the past decade have suggested antipsychotics come with serious risks, including death, which has escalated the need for alternative treatments. Dr. Watt said trazodone is increasingly filling the void left by antipsychotics. The drug is believed to help alleviate some of the challenging symptoms of dementia, such as aggression.

According to the study, one-third of Ontario seniors with dementia living in a long-term care facility in 2013 were given antipsychotic drugs to manage their symptoms. Just over 21 per cent were given trazodone.

Dr. Watt’s study focused only on the fall and fracture risk associated with trazodone and didn’t evaluate any other potential safety concerns.

She looked at Ontario health data for nearly 6,600 seniors in long-term care given a new prescription for trazodone and 2,875 who were dispensed an antipsychotic drug. They found the fall and fracture risk for seniors on both drugs were similar.

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As health professionals move to rely on trazodone as an alternative for dementia patients, Dr. Watt said they should understand the drug isn’t necessarily safer and can still expose patients to risks. That’s why it’s important to look beyond drugs to treat patients with difficult dementia symptoms, Dr. Watt said.

In a commentary published with the study, researchers underscore the importance of non-drug-related treatments. For instance, health professionals can see if the dementia patient is experiencing pain, lack of sleep or other physical problems; provide the patient with an activity that can give him or her purpose; and ensure their physical environment isn’t overstimulating.

“We owe this to older adults with dementia, who are some of the most vulnerable members of our society,” wrote Elia Abi-Jaoude, lead author of the commentary who works in psychiatry at the University Health Network.

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