title: Changing Pattern of Sedative Use in Older Adults: A Population-Based Cohort Study.
abstract: Benzodiazepine medications have well-documented side effects, and their prescription rates in older adults have been declining. Trazodone and quetiapine are medications with sedative properties when used at low doses and are commonly used off-label for sleep or behavioral symptoms in older adults.
  
  
  
  Our objective was to describe the shifting patterns of sedative prescription in older adults over time by comparing changes in benzodiazepine, trazodone, and quetiapine dispensing between community and long-term care settings.
  
  
  
  We conducted a population-based serial cross-sectional study to compare the patterns of sedative dispensing (specifically, benzodiazepines, trazodone, and quetiapine) to individuals aged ≥66 years between 1 January 2002 and 31 March 2013 in Ontario, Canada. We compared rates of use between long-term care and community settings and used linear regression models to characterize the magnitude and direction of the rate of change in sedative use by age, sex, and dementia status.
  
  
  
  The dispensing of trazodone and quetiapine increased over time, and this coincided with a decrease in benzodiazepine dispensing. This pattern was particularly apparent in the oldest cohort and in those with dementia. Benzodiazepines, trazodone, and quetiapine were associated with high rates of psychotropic polypharmacy. Overall trends were similar in long-term care and the community.
  
  
  
  While benzodiazepine prescribing is declining among older adults in Ontario over time, there is a corresponding shift towards low-dose, off-label prescribing of trazodone and quetiapine and psychotropic polypharmacy. These prescribing trends highlight sedative substitution and reinforce the need to confirm efficacy and safety of this practice.
authors.affiliation: Centre for Mental Health, University Health Network, Toronto, ON, Canada. Andrea.iaboni@uhn.ca.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Andrea.iaboni@uhn.ca.|Toronto Rehabilitation Institute, 550 University Ave, 5-105-3, Toronto, ON, M5G 2A2, Canada. Andrea.iaboni@uhn.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: Iaboni
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Institute of Health, Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bronskill
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Katelyn B
authors.initials: KB
authors.lastname: Reynolds
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Institute of Health, Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.|Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, ON, Canada.|Hurvitz Brain Sciences Program Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: Centre for Mental Health, University Health Network, Toronto, ON, Canada.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Alastair
authors.initials: A
authors.lastname: J Flint
mesh_terms: D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy*; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008134:Long-Term Care; D056687:Off-Label Use; D009864:Ontario; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012107:Research Design
chemical_list: D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs; D001569:Benzodiazepines