Antidepressant guidelines for long-term care residents with advanced frailty
This project was undertaken because there are a high number of long-term care (LTC) residents taking antidepressants, meaning the potential benefits and harms (e.g., risk of falls, cognitive impairment) should be considered more carefully.
Findings: Based on our systematic review and meta-analyses, we conclude there is considerable uncertainty about the benefit of antidepressants for depression in frail, older adults with and without dementia or the neuropsychiatric symptoms of dementia compared to placebo. However, there are individual patients who might benefit from antidepressants.
Impact of findings: This review contributes to the existing dialogue of polypharmacy and appropriate prescribing in frail older adults and may lead to more judicious prescribing of antidepressants for depression and the neuropsychiatric symptoms of dementia in frail older adults with and without dementia. This could lead to a reduction in antidepressant use in the frail older adults which could reduce medication side effects, and as a result, increase quality of life. In addition, caregiver burden may be reduced if fewer medications are dispensed and there are fewer additional care needs for medication side effects.
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About the Project
There are over 200,000 elderly in LTC facilities across Canada. Residents in long-term care are typically frail and commonly have multiple medical conditions, dementia and short life expectancy. However, many treatment decisions for frail elderly adults are based on standards of care using evidence developed for younger, healthier populations. This practice can lead to the inappropriate use of medications, resulting in poor outcomes and increased costs. The frequent prescribing of antidepressants for elderly residents with advanced frailty and/or dementia is of particular concern, with use in approximately 40% of residents in LTC.
The use of antidepressants in frail, older adults is an important topic due to concerns about effectiveness of the treatment of depressive symptoms for older adults who are frail.
This is why we proposed a knowledge synthesis of the available evidence and clinical expert opinion to develop practice guidelines for prescribers and a decision aid to facilitate discussions about appropriate antidepressant use for LTC residents with advanced frailty and/or dementia.
For more details on the project rationale, hypothesis, objectives and research plan, click here.
Laurie Mallery, MD -- Dalhousie University
Constance LeBlanc, DSS, MD, CCFP, FCFP, MAEd -- Dalhousie University
Tanya MacLeod, MSc -- Dalhousie University
Knowledge Users and Partners:
Atlantic Long-Term Care Network
Canadian Coalition on Seniors Mental Health
Northwood Long-Term Care
RxFiles LTC Resource
Project Contact: Laurie Mallery -- firstname.lastname@example.org