Volume 66, Issue 10 p. 1963-1971
Clinical Investigation

Low-Dose Trazodone, Benzodiazepines, and Fall-Related Injuries in Nursing Homes: A Matched-Cohort Study

Susan E. Bronskill PhD

Corresponding Author

Susan E. Bronskill PhD

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada

Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Corresponding Author: Susan E. Bronskill, Institute for Clinical Evaluative Sciences, G1–06, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5. E-mail: [email protected]Search for more papers by this author
Michael A. Campitelli MPH

Michael A. Campitelli MPH

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

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Andrea Iaboni MD

Andrea Iaboni MD

Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada

Departments of Psychiatry

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Nathan Herrmann MD

Nathan Herrmann MD

Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Departments of Psychiatry

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Jun Guan MSc

Jun Guan MSc

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

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Laura C. Maclagan MSc

Laura C. Maclagan MSc

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

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Jennifer Watt MD

Jennifer Watt MD

Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Medicine, University of Toronto, Toronto, Ontario, Canada

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Paula A. Rochon MD, MPH

Paula A. Rochon MD, MPH

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada

Medicine, University of Toronto, Toronto, Ontario, Canada

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Andrew M. Morris MD, SM

Andrew M. Morris MD, SM

Medicine, University of Toronto, Toronto, Ontario, Canada

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Lianne Jeffs RN, PhD

Lianne Jeffs RN, PhD

Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada

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Chaim M. Bell MD, PhD

Chaim M. Bell MD, PhD

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

Medicine, University of Toronto, Toronto, Ontario, Canada

Divisions of General Internal Medicine and Infectious Diseases, Sinai Health System, Toronto, Ontario, Canada

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Colleen J. Maxwell PhD

Colleen J. Maxwell PhD

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

Schools of Pharmacy

Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada

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First published: 24 September 2018
Citations: 28

Abstract

Objectives

To evaluate whether risk of fall-related injuries differs between nursing home (NH) residents newly dispensed low-dose trazodone and those newly dispensed benzodiazepines.

Design

Retrospective, 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.

Setting

All NHs in Ontario, Canada.

Participants

Propensity 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).

Measurements

Hospitalization (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.

Results

Cumulative 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.

Conclusion

New 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.