Antipsychotic drugs are among the most commonly used treatments for managing hyperactive behavioral symptoms of delirium like agitation and psychosis in older adults following hospitalization. These drugs, however, are linked to a broad range of negative effects like cognitive decline, falls, urinary tract infections, stroke, and increased mortality.
Trazodone has emerged as a potentially safer alternative for managing these symptoms, with sedative effects at low doses. Until now, however, evidence directly comparing the drug with antipsychotic medications in older adults has been limited.
In the current study, researchers compared outcomes of adults aged 65 years and older who received trazodone or an antipsychotic medication such as quetiapine, risperidone, or olanzapine after experiencing delirium when admitted to hospital. Over 11,500 patients used tazadone, and close to 30,000: an antipsychotic medication.
Ultimately, researchers found that patients taking trazodone were 20% less likely to be rehospitalized for delirium, 16% less likely to develop a urinary tract infection, and 16% less likely to experience all-cause mortality. No significant difference was seen for falls, pneumonia, or stroke. Reduced rehospitalization risk was consistent when compared with risperidone and olanzapine, but not quetiapine.
“The lower risk of rehospitalization among patients treated with trazodone may be related to fewer hospital admissions for delirium and urinary tract infections,” said Dae Hyun Kim, MD, associate director and senior scientist at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, in a press release.
“By contrast, prior research has shown that antipsychotic medications are associated with greater cognitive decline and can affect the urinary system in ways that may raise the risk of urinary retention, incontinence, and infections. Although possibility of residual bias cannot be excluded, these effects may help explain why antipsychotics were linked to higher risks of delirium and rehospitalization in our study,” he noted.
Sources: EurekAlert, The Lancet Healthy Longevity