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Changing Pattern of Sedative Use in Older Adults: A Population-Based Cohort Study

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Abstract

Background

Benzodiazepine medications have well-documented side effects, and their prescription rates in older adults have been declining. Trazodone and quetiapine are medications with sedative properties when used at low doses and are commonly used off-label for sleep or behavioral symptoms in older adults.

Objective

Our objective was to describe the shifting patterns of sedative prescription in older adults over time by comparing changes in benzodiazepine, trazodone, and quetiapine dispensing between community and long-term care settings.

Methods

We conducted a population-based serial cross-sectional study to compare the patterns of sedative dispensing (specifically, benzodiazepines, trazodone, and quetiapine) to individuals aged ≥66 years between 1 January 2002 and 31 March 2013 in Ontario, Canada. We compared rates of use between long-term care and community settings and used linear regression models to characterize the magnitude and direction of the rate of change in sedative use by age, sex, and dementia status.

Results

The dispensing of trazodone and quetiapine increased over time, and this coincided with a decrease in benzodiazepine dispensing. This pattern was particularly apparent in the oldest cohort and in those with dementia. Benzodiazepines, trazodone, and quetiapine were associated with high rates of psychotropic polypharmacy. Overall trends were similar in long-term care and the community.

Conclusions

While benzodiazepine prescribing is declining among older adults in Ontario over time, there is a corresponding shift towards low-dose, off-label prescribing of trazodone and quetiapine and psychotropic polypharmacy. These prescribing trends highlight sedative substitution and reinforce the need to confirm efficacy and safety of this practice.

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Acknowledgments

These datasets were linked using unique encoded identifiers and analyzed at ICES. The authors thank Brogan Inc., Ottawa, for the use of their Drug Product and Therapeutic Class Database. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors, and not necessarily those of CIHI.

Author information

Authors and Affiliations

  1. Centre for Mental Health, University Health Network, Toronto, ON, Canada

    Andrea Iaboni & Alastair J. Flint

  2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Andrea Iaboni, Katelyn B. Reynolds, Nathan Herrmann & Alastair J. Flint

  3. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Susan E. Bronskill, Xuesong Wang & Paula A. Rochon

  4. Institute of Health, Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Susan E. Bronskill & Paula A. Rochon

  5. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Paula A. Rochon

  6. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Paula A. Rochon

  7. Hurvitz Brain Sciences Program Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Nathan Herrmann

  8. Toronto Rehabilitation Institute, 550 University Ave, 5-105-3, Toronto, ON, M5G 2A2, Canada

    Andrea Iaboni

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  1. Andrea Iaboni
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Correspondence to Andrea Iaboni.

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Funding

This work was supported by a Grant from the University Health Network Psychiatric Consultants Research Fund and a Team Grant (OTG-88591) from the Canadian Institutes of Health Research (CIHR) Institute of Nutrition, Metabolism, and Diabetes. This study was also supported by ICES, which is funded by an annual Grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

Conflict of interest

AI, KBR, and XW have no conflicts of interest or financial disclosures. SEB, in the past 2 years, has received Grant support from the CIHR and the Technology Evaluation in the Elderly (TVN) National Centre for Excellence. PAR, in the past 2 years, has received Grant support from the CIHR and the Ontario Institute for Cancer Research. NH has received research funding and consultant fees from Lundbeck, Roche, Abbvie, Astellas, Merck, and Lilly. AF, in the past 2 years, has received Grant support from the National Institute of Mental Health, the CIHR, the Ontario Brain Institute, the Buchan Foundation, Lundbeck, and Servier. He has also received honoraria from Pfizer Canada.

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Iaboni, A., Bronskill, S.E., Reynolds, K.B. et al. Changing Pattern of Sedative Use in Older Adults: A Population-Based Cohort Study. Drugs Aging 33, 523–533 (2016). https://doi.org/10.1007/s40266-016-0380-3

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