Comparison of Fracture and Fall Risk in Elderly Dementia Patients

Prevalence of Dementia in Canada

In Canada, dementia affects approximately 25% of individuals over the age of 85 and around 62% of residents in continuing-care facilities. The behavioral and psychological symptoms associated with dementia can be particularly distressing for both patients and caregivers, with nearly half of those affected exhibiting aggressive behavior.

Use of Antipsychotic Drugs and Trazodone

Despite limited evidence supporting their effectiveness, healthcare providers often prescribe antipsychotic medications and the antidepressant trazodone to alleviate behavioral symptoms in elderly dementia patients. However, antipsychotic drugs are known to have side effects that may pose risks to the elderly, including an increased likelihood of falls, fractures, heart attack, and pneumonia.

Trazodone as a Safer Alternative

Trazodone is increasingly viewed as a safer alternative for treating dementia-related symptoms in older patients in Canada. Nevertheless, it is important to note that trazodone can also lead to side effects such as drowsiness, dizziness, and low blood pressure, which heighten the risk of falls.

Research Study Overview

Researchers in Ontario, Canada, investigated the fracture and fall risk among elderly dementia patients prescribed antipsychotic medications versus trazodone. Their findings were published in the Canadian Medical Association Journal. The study utilized health administrative databases to gather information on dementia patients aged 66 and older living in long-term care facilities. The focus was on new users of antipsychotics or trazodone from December 2009 to December 2013, comparing the incidence of falls or major fractures within 90 days of initiating treatment.

Study Results

The study included 6,588 patients taking trazodone and 2,875 patients on antipsychotics. The results indicated that trazodone was associated with similar rates of falls and major fractures as antipsychotics. However, patients on trazodone exhibited a lower risk of mortality compared to those taking antipsychotic medications.

Conclusions and Recommendations

The researchers concluded that trazodone does not present a universally safer option than antipsychotics for elderly dementia patients, as it is linked to comparable risks of fractures and falls. Dr. Watt, the lead author of the study, expressed hope that these findings would facilitate meaningful discussions between patients, caregivers, and clinicians regarding the benefits and risks of various treatment options. Furthermore, Dr. Watt emphasized the necessity of exploring non-pharmacological strategies for managing behavioral issues in older adults with dementia, such as behavioral interventions, environmental modifications, and caregiver support, to mitigate the risks associated with drug treatments.

References

Watt JA, Gomes T, Bronskill SE, et al. Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study. CMAJ 2018 November 26;190:E1376-83. Doi:10.1503/cmaj.180551.
Press release. Trazodone associated with similar risk of falls and major fractures as antipsychotics in seniors with dementia. Canadian Medical Association Journal https://www.eurekalert.org/pub_releases/2018-11/cmaj-taw112118.php