title: Initiation of Antidepressant Medication After Hip Fracture in Community-Dwelling Older Adults.
abstract: OBJECTIVE
  To evaluate the incidence, characteristics, and correlates of antidepressant drug therapy initiation among community-dwelling older adults following hip fracture.
  
  
  METHODS
  Retrospective cohort study using linked, population-based administrative data.
  
  
  METHODS
  Province of Ontario, Canada.
  
  
  METHODS
  Older adults, aged 65 years or older, with a hip fracture and hip fracture surgery between April 1, 2003, and February 28, 2011. The study sample was restricted to individuals who returned home following surgery and who had not been dispensed an antidepressant in the year prior to their fracture (N=25,436).
  
  
  METHODS
  We determined the incidence of new antidepressant use defined by the dispensing of antidepressant drug therapy within 90 days of discharge home. We identified independent correlates of antidepressant initiation using multivariate regression.
  
  
  RESULTS
  Overall, antidepressants were newly initiated in 8.8% of older adults with hip fracture in the 90 days following hospital discharge. There was a statistically significant, 1.3-fold increase in incidence of antidepressant prescribing from 2003 to 2010. Trazodone, frequently prescribed at a low dose, accounted for 39.0% of newly dispensed antidepressants, followed by selective serotonin reuptake inhibitors (36.9%). Rehabilitation admission, psychiatric evaluation, a diagnosis of dementia, and baseline benzodiazepine use were the strongest independent correlates of antidepressant initiation.
  
  
  CONCLUSIONS
  The period after a hip fracture is associated with a high rate of initiation of antidepressant therapy. The data raise the possibility that antidepressants are frequently prescribed off-label in these patients. Further research is needed to investigate the safety and efficacy of antidepressant use in this vulnerable population.
authors.affiliation: Departments of Psychiatry, University Health Network, and University of Toronto, Toronto, Ontario, Canada. Electronic address: andrea.iaboni@uhn.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: Iaboni
authors.affiliation: Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
authors.forename: Dallas P
authors.initials: DP
authors.lastname: Seitz
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Christina C
authors.initials: CC
authors.lastname: Diong
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
authors.affiliation: Departments of Psychiatry, University Health Network, and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Flint
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006620:Hip Fractures / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D054539:Medication Therapy Management; D015999:Multivariate Analysis; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D014196:Trazodone / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone
keywords: Antidepressant medication; depression; hip fracture; rehabilitation