Doctors more often prescribe the antidepressant trazodone of elderly people with dementia in long-term care homes as a result of increased concerns about antipsychotics.
But there are many unanswered questions about the safety of the drug in patients with dementia and Canadian researchers have identified whether it is a safer alternative to antipsychotics.
Their study, published Monday in the Canadian Journal of Medical Association, found that older people with long-term care who take trazodone face an increased risk of falls and fractures. Risks are at the same level as the decline and the risk of fractures associated with antipsychotics, a study found.
Leading author Jennifer Wat, a geriatrist at St. Michael's Hospital in Toronto, said the findings should send the message that trazodone is no longer a safer alternative to antipsychotics in patients with dementia in long-term care.
"For several years now, we know that antipsychotics are bad," said Dr. Wat in an interview. "We did not know that other drugs are just as bad".
Many elderly people with dementia in long-term care receive antipsychotic drugs to manage agitation, aggression and other common symptoms of the disease. Despite this, there is little evidence to show that these drugs are effective and there are fears about dangers such as an increased risk of heart attack, as well as falls and fractures. This has led many health professionals to call for drug-free treatment for this disease.
Many studies published in the past decade have suggested that antipsychotics come with serious risks, including death, which has escalated the need for alternative treatments. Dr Wat said that trazodone is increasingly filling the gap left by antipsychotics. The drug is believed to help alleviate some of the causing symptoms of dementia, such as aggression.
According to the study, a third of the elderly ontario dementia living in a long-term care facility in 2013 received antipsychotic drugs to manage their symptoms. More than 21 per cent were given trazodone.
Dr. Wat's study focussed solely on the risk of fracture and trastodon-associated fracture and did not evaluate any potential safety concerns.
She reviewed health data in Ontario for nearly 6,600 elderly people in long-term care given the new prescription for trazodone and 2,875 who were given an antipsychotic medication. They found that the fall and the risk of fractures for the elderly of both drugs were similar.
While health professionals are moving to rely on trazodone as an alternative to patients with dementia, Dr. Wat said they need to understand that the drug is not necessarily safer and can still expose patients to risks. It is therefore important to look beyond medicine to treat patients with severe dementia symptoms, said Dr. Wat.
In a comment published in the study, researchers emphasize the importance of non-drug-related treatments. For example, health workers can see if a patient with dementia has pain, sleep or other physical problems; provides the patient with an activity that may give him the intention; and to ensure their physical environment is not too stimulating.
"We owe this to older demented adults who are some of the most vulnerable members of our society," wrote Elia Ai-Joude, the lead author of the commentary on psychiatry at the University Health Network.