Prolonged Use of Antidepressants Among Older People Residing in Long-Term Care Facilities

Abstract

Objectives

Antidepressants are commonly used by older people and use increases during transition to long-term care facilities (LTCFs); however, little is known regarding duration of use following LTCF entry. This study aimed to examine duration of antidepressant use among new and existing antidepressant users after LTCF entry.

Design

Retrospective cohort study.

Setting and Participants

Non-Indigenous individuals aged 65 to 105 years who entered LTCFs in 2 Australian states between 2015 and 2018 and received an antidepressant between LTCF entry and ≤60 days after, were included.

Methods

Cumulative incidence function and Fine-Gray regression models adjusted for age, sex, and LTCF entry year, accounted for the competing risk of death, and estimated the subdistribution hazard ratio (sHR) and 95% confidence interval (95% CI) for antidepressant discontinuation for all, new, and existing users.

Results

Overall, 28,426 individuals entering 1035 LTCFs were included, of whom 22,365 (78.7%) were existing antidepressant users and 6061 (21.3%) were new users. Selective serotonin reuptake inhibitors and mirtazapine were commonly utilized. Overall, 36.1% (95% CI 35.1–37.1) of residents discontinued antidepressants (median follow-up 614 days, interquartile range 338–1002) following entry and 50.3% (95% CI 49.4–51.2) were dispensed enough to last until death. New antidepressant users had a 36% (adjusted sHR, 1.36; 95% CI, 1.29–1.44) higher risk of discontinuation compared with existing users.

Conclusions and Implications

Prolonged antidepressant use is common in LTCFs, and therapy is often continued until the end-of-life. Initiating nonpharmacological alternatives, regular review of antidepressant appropriateness, and seeking discontinuation opportunities where appropriate can minimize potentially inappropriate antidepressant use and risk of harm.