Hughes Georgina A, Inacio Maria C, Rowett Debra, Lang Catherine, Jorissen Robert N, Corlis Megan, Sluggett Janet K
University of South Australia, UniSA Clinical & Health Sciences, Adelaide, South Australia, Australia.
Registry of Senior Australians (ROSA), South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
Br J Clin Pharmacol. 2025 Jun;91(6):1749-1759. doi: 10.1111/bcp.16403. Epub 2025 Jan 31.
Antidepressant use increases around long-term care facility (LTCF) entry, and initiation during hospitalizations may contribute to this. This study characterized the care setting (i.e., community-based, hospital or LTCF) where antidepressants were initiated and determined associated resident characteristics.
A cross-sectional study including non-Indigenous individuals aged 65-105 years who entered LTCFs in two Australian states during 2015-2019, and were dispensed an antidepressant within 2 months, was conducted. Care settings (community-based, hospital or LTCF) were determined from linked LTCF records, and hospitalizations ≤30 days before LTCF entry. Pharmaceutical claims before and after LTCF entry were screened to determine antidepressant initiation. Multivariate multinomial logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for resident characteristics associated with care settings of antidepressant initiation.
This study included 34 525 residents from 1046 LTCFs. Overall, 27 160 (78.7%) commenced antidepressants prior to entry, 2552 (7.4%) in hospital and 4813 (13.9%) in LTCFs. Mirtazapine constituted 44.8% (n = 1143) of antidepressants initiated in hospitals and 39.5% (n = 1902) in LTCFs. Residents who were aged ≥90 years were more likely to start an antidepressant in the LTCF compared to community-based settings (aOR = 1.97, 95% CI 1.74-2.23). Residents recently using a psychotropic were more likely to start an antidepressant in community-based settings before LTCF entry, compared to a hospital or LTCF.
Individuals receiving antidepressants during transition to LTCFs are often already taking antidepressants prior to entry. Future interventions to optimize antidepressant use in LTCFs should consider setting, recency and indication for antidepressant initiation, and ongoing monitoring for safety.
在长期护理机构（LTCF）入住前后抗抑郁药的使用有所增加，住院期间开始用药可能是原因之一。本研究对开始使用抗抑郁药的护理环境（即社区、医院或长期护理机构）进行了特征描述，并确定了相关的居民特征。
开展了一项横断面研究，纳入2015年至2019年期间在澳大利亚两个州入住长期护理机构、年龄在65至105岁之间的非原住民个体，且这些个体在入住后2个月内配用了抗抑郁药。护理环境（社区、医院或长期护理机构）根据长期护理机构的关联记录以及入住长期护理机构前30天内的住院情况来确定。对入住长期护理机构前后的药品报销记录进行筛查，以确定抗抑郁药的起始使用情况。多变量多项逻辑回归分析估计了与抗抑郁药起始使用护理环境相关的居民特征的调整优势比（aOR）和95%置信区间（95%CI）。
本研究纳入了来自1046家长期护理机构的34525名居民。总体而言，27160名（78.7%）在入住前开始使用抗抑郁药，2552名（7.4%）在医院开始使用，4813名（13.9%）在长期护理机构开始使用。米氮平在医院开始使用的抗抑郁药中占44.8%（n = 1143），在长期护理机构开始使用的抗抑郁药中占39.5%（n = 1902）。与社区环境相比，90岁及以上的居民在长期护理机构开始使用抗抑郁药的可能性更大（aOR = 1.97，95%CI 1.74 - 2.23）。与医院或长期护理机构相比，近期使用过精神药物的居民在入住长期护理机构前在社区环境中开始使用抗抑郁药的可能性更大。
在转入长期护理机构期间接受抗抑郁药治疗的个体在入住前往往已经在服用抗抑郁药。未来优化长期护理机构中抗抑郁药使用的干预措施应考虑用药环境、用药近期情况和抗抑郁药起始使用的适应症，以及持续的安全性监测。
