A recent study published in The Lancet Healthy Longevity indicates that older adults hospitalized with delirium may have better outcomes when treated with trazodone, a medication commonly prescribed for depression and sleep disorders, compared to standard antipsychotic drugs. Delirium is a sudden onset of confusion that frequently affects older patients during or after hospital stays. Although medications are often used to manage delirium, there has been limited evidence on which treatments are safest.
Researchers analyzed national health data from adults aged 65 and above who received medication for delirium following hospital admission. The study compared outcomes between those treated with trazodone and those given atypical antipsychotics such as quetiapine, risperidone, or olanzapine.
The results showed that patients receiving trazodone had lower mortality rates and were less likely to be rehospitalized than those taking antipsychotic medications. There was no significant difference between the two groups regarding falls or fractures—an important consideration since sedating drugs can increase these risks among older adults. The findings suggest that trazodone could be a safer alternative for managing delirium in situations where medication is necessary.
To improve the reliability of their conclusions, researchers used target trial emulation—a method designed to make observational data more closely resemble randomized clinical trials. Despite these findings, the authors emphasized that non-drug approaches should remain the first line of treatment for delirium.
"The lower risk of rehospitalization among patients treated with trazodone may be related to fewer hospital admissions for delirium and urinary tract infections," said Dae Hyun Kim, MD, MPH, ScD, associate director and senior scientist at Hebrew SeniorLife's Hinda and Arthur Marcus Institute for Aging Research. "By contrast, prior research has shown that antipsychotic medications are associated with greater cognitive decline and can affect the urinary system in ways that may raise the risk of urinary retention, incontinence, and infections. Although possibility of residual bias cannot be excluded, these effects may help explain why antipsychotics were linked to higher risks of delirium and rehospitalization in our study."
Other contributors to the research included Chun-Ting Yang (Brigham and Women's Hospital), James M. Wilkins (McLean Hospital), Kevin T. Pritchard (Marcus Institute at Hebrew SeniorLife), Qiaoxi Chen (Brigham and Women's Hospital), Robert J. Glynn (Harvard Medical School; Brigham and Women's Hospital), and Jerry Avorn (Harvard Medical School; Brigham and Women's Hospital).
