Hughes Georgina A, Inacio Maria C, Rowett Debra, Caughey Gillian E, Air Tracy, Lang Catherine, 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.
Registry of Senior Australians (ROSA), South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Allied Health & Human Performance, Adelaide, South Australia, Australia.
J Am Med Dir Assoc. 2025 Apr;26(4):105482. doi: 10.1016/j.jamda.2024.105482. Epub 2025 Feb 13.
Antidepressants are commonly used by older people and use increases during transition to long-term care facilities (LTCFs); however, little is known regarding duration of use following LTCF entry. This study aimed to examine duration of antidepressant use among new and existing antidepressant users after LTCF entry.
Retrospective cohort study.
Non-Indigenous individuals aged 65 to 105 years who entered LTCFs in 2 Australian states between 2015 and 2018 and received an antidepressant between LTCF entry and ≤60 days after, were included.
Cumulative incidence function and Fine-Gray regression models adjusted for age, sex, and LTCF entry year, accounted for the competing risk of death, and estimated the subdistribution hazard ratio (sHR) and 95% confidence interval (95% CI) for antidepressant discontinuation for all, new, and existing users.
Overall, 28,426 individuals entering 1035 LTCFs were included, of whom 22,365 (78.7%) were existing antidepressant users and 6061 (21.3%) were new users. Selective serotonin reuptake inhibitors and mirtazapine were commonly utilized. Overall, 36.1% (95% CI 35.1-37.1) of residents discontinued antidepressants (median follow-up 614 days, interquartile range 338-1002) following entry and 50.3% (95% CI 49.4-51.2) were dispensed enough to last until death. New antidepressant users had a 36% (adjusted sHR, 1.36; 95% CI, 1.29-1.44) higher risk of discontinuation compared with existing users.
Prolonged antidepressant use is common in LTCFs, and therapy is often continued until the end-of-life. Initiating nonpharmacological alternatives, regular review of antidepressant appropriateness, and seeking discontinuation opportunities where appropriate can minimize potentially inappropriate antidepressant use and risk of harm.
老年人常用抗抑郁药，且在转至长期护理机构（LTCF）期间用药量增加；然而，对于入住LTCF后的用药时长知之甚少。本研究旨在调查新的和现有的抗抑郁药使用者在入住LTCF后的用药时长。
回顾性队列研究。
纳入2015年至2018年期间在澳大利亚两个州入住LTCF的65至105岁非原住民个体，这些个体在入住LTCF后至入住后≤60天内接受了抗抑郁药治疗。
累积发病率函数和Fine-Gray回归模型对年龄、性别和LTCF入住年份进行了调整，考虑了死亡的竞争风险，并估计了所有使用者、新使用者和现使用者停用抗抑郁药的亚分布风险比（sHR）和95%置信区间（95%CI）。
总体而言，纳入了入住1035家LTCF的28426名个体，其中22365名（78.7%）为现有的抗抑郁药使用者，6061名（21.3%）为新使用者。选择性5-羟色胺再摄取抑制剂和米氮平使用较为普遍。总体而言，36.1%（95%CI 35.1-37.1）的居民在入住后停用了抗抑郁药（中位随访614天，四分位间距338-1002），50.3%（95%CI 49.4-51.2）的居民获得了足够的药物直至死亡。与现使用者相比，新的抗抑郁药使用者停用的风险高36%（调整后的sHR，1.36；95%CI，1.29-1.44）。
在LTCF中，长期使用抗抑郁药很常见，且治疗通常会持续到生命结束。启动非药物替代方案、定期审查抗抑郁药的适用性，并在适当的时候寻求停药机会，可以将潜在的不适当抗抑郁药使用和伤害风险降至最低。
