Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2018 Oct;66(10):1963-1971. doi: 10.1111/jgs.15519. Epub 2018 Sep 24.
To evaluate whether risk of fall-related injuries differs between nursing home (NH) residents newly dispensed low-dose trazodone and those newly dispensed benzodiazepines.
Retrospective, matched cohort study in linked, population-based administrative data. Matching was based on propensity score ( ± 0.2 standard deviations of the score as a caliper), age ( ± 1 year), sex, frailty status, and history of dementia. The derived propensity score included demographic characteristics, clinical comorbidities, cognitive and functional status, and risk factors for falls.
All NHs in Ontario, Canada.
Propensity score-matched pairs of residents aged 66 and older who received a full clinical assessment between April 1, 2010, and March 31, 2015 (N=7,791).
Hospitalization (emergency department visit or acute care admission) for a fall-related injury within 90 days of exposure. Subdistribution hazard functions accounted for competing risk of death. Sensitivity analyses were used to examine falls resulting in hip or wrist fracture only, as well as different lengths of follow-up at 30, 60, and 180 days.
Cumulative incidence of a fall-related injury in the 90 days after index was 5.7% for low-dose trazodone users and 6.0% for benzodiazepine users (between-group change=-0.29, 95% confidence interval (CI)=-1.02-0.44]; hazard ratio=0.94, 95% CI=0.83-1.08). Findings were consistent across sensitivity analyses.
New use of low-dose trazodone was no safer with respect to a risk of a fall-related injury than new use of benzodiazepines. Additional studies to compare the effectiveness and risks of low-dose trazodone with those of a variety of psychotropic drug therapies are required in light of increasing trends in the use of trazodone in NHs.
评估新处方低剂量曲唑酮和新处方苯二氮䓬类药物的养老院（NH）居民跌倒相关伤害风险是否不同。
在基于倾向评分（ ± 评分的 0.2 个标准差作为卡尺）、年龄（ ± 1 岁）、性别、虚弱状态和痴呆史的匹配的回顾性、匹配队列研究。得出的倾向评分包括人口统计学特征、临床合并症、认知和功能状态以及跌倒风险因素。
加拿大安大略省的所有 NH。
2010 年 4 月 1 日至 2015 年 3 月 31 日期间接受全面临床评估且年龄在 66 岁及以上的符合条件的居民（N=7791）。
暴露后 90 天内因跌倒相关伤害而住院（急诊就诊或急性护理入院）。亚分布风险函数考虑了死亡的竞争风险。敏感性分析用于检查仅导致髋部或腕部骨折的跌倒以及在 30、60 和 180 天的不同随访时间的跌倒。
低剂量曲唑酮使用者在指数后 90 天内跌倒相关伤害的累积发生率为 5.7%，苯二氮䓬类药物使用者为 6.0%（组间变化=-0.29，95%置信区间（CI）=-1.02-0.44）；风险比=0.94，95%CI=0.83-1.08）。敏感性分析结果一致。
与新使用苯二氮䓬类药物相比，新使用低剂量曲唑酮在跌倒相关伤害风险方面并没有更安全。鉴于曲唑酮在 NH 中的使用呈上升趋势，需要进行更多比较低剂量曲唑酮与各种精神药物治疗的有效性和风险的研究。
