Low-Dose Trazodone, Benzodiazepines, and Fall-Related Injuries in Nursing Homes: A Matched-Cohort Study
Low-Dose Trazodone, Benzodiazepines, and Fall-Related Injuries in Nursing Homes: A Matched-Cohort Study
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DOI：
10.1111/jgs.15519
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发表时间：
2018-10-01
影响因子：
6.3
通讯作者：
Maxwell, Colleen J.
中科院分区：
文献类型：
--
作者：
Bronskill, Susan E.;Campitelli, Michael A.;Maxwell, Colleen J.
ObjectivesTo evaluate fall-related injury risk between nursing home（NH）residents newly dispensed low-dose trazodone and those newly dispensed benzodiazepines.DesignRetrospective，matched cohort study in linked，population-based administrative data.匹配基于倾向评分（评分的0.2标准差作为卡尺）、年龄（1岁）、性别、虚弱状态和痴呆病史。导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福尔斯的风险因素。设置加拿大安大略的所有NHS。在接触后90天内因跌倒受伤住院（急诊或急诊入院）。子分布风险函数解释了竞争性死亡风险。敏感性分析用于检查仅导致髋部或腕部骨折的福尔斯，以及在30、60和180 day.Results90天内随访的不同时间长度，低剂量曲唑酮使用者跌倒相关损伤的累积发生率为5.7%，苯二氮卓类药物使用者为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）。结果是一致的敏感性analysis.ConclusionNew使用低剂量曲唑酮是没有更安全的下降相关的伤害比新使用的苯二氮卓类药物的风险。鉴于在NHS中使用曲唑酮的趋势增加，需要进行额外的研究，以比较低剂量曲唑酮与各种精神药物治疗的有效性和风险。
ObjectivesTo evaluate whether risk of fall-related injuries differs between nursing home (NH) residents newly dispensed low-dose trazodone and those newly dispensed benzodiazepines.DesignRetrospective, 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.SettingAll NHs in Ontario, Canada.ParticipantsPropensity 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).MeasurementsHospitalization (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.ResultsCumulative 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.ConclusionNew 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.