Study reveals that alternatives to antipsychotics in the elderly also have disadvantages

Doctors are prescribing trazodone, an antidepressant, more commonly for elderly people with dementia in long-term care facilities, because of growing concerns about antipsychotics.

However, many questions remain unanswered about the safety of the drug in patients with dementia. Canadian researchers have therefore sought to determine whether there was a safer alternative to antipsychotics.

Their study, published Monday in the Canadian Medical Association Journal, found that long-term elderly people taking trazodone are at increased risk for falls and fractures. Research has shown that the risks are equivalent to the risk of falling and fracture associated with antipsychotics.

Lead author Jennifer Watt, a geriatrician at St. Michael's Hospital in Toronto, said the results should show that trazodone is not necessarily a safer alternative to antipsychotics for dementia patients in long-term care.

"For many years, we knew that antipsychotics were bad," Dr. Watt said in an interview. "We did not know that other drugs were so bad."

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

A number of studies published over the past decade have suggested that antipsychotics pose serious risks, including death, which has increased the need for alternative treatments. Dr. Watt said that trazodone is filling more and more the void left by antipsychotics. The drug is thought to help alleviate some of the difficult symptoms of dementia, such as aggression.

According to the study, one-third of seniors living with dementia in Ontario and living in a long-term care facility in 2013 received antipsychotics to manage their symptoms. Just over 21% received trazodone.

Dr. Watt's study focused only on the risk of falling and fracture associated with trazodone and did not assess any other potential safety issues.

It examined Ontario's health data for nearly 6,600 long-term care seniors who received a new trazodone prescription and 2,875 people who received an antipsychotic drug. They found that the risk of falls and fractures in the elderly taking both drugs was similar.

While healthcare professionals are increasingly opting for trazodone as an alternative for patients with dementia, Dr. Watt said they should understand that the drug is not necessarily safer and may still expose patients at risk. That's why it's important to look beyond drugs to treat patients with difficult dementia symptoms, said Dr. Watt.

In a commentary published with the study, researchers stress the importance of non-drug treatments. For example, health professionals can see if the patient with dementia is experiencing pain, lack of sleep or other physical problems; give the patient an activity that can give him a goal; and make sure their physical environment is not too stimulating.

"We owe it to the elderly with dementia, who are among the most vulnerable members of our society," wrote Elia Abi-Jaoude, lead author of the commentary that works in psychiatry at the University Health Network.