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

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.