Oral Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2026

Antidepressant use and safety in residential aged care homes: using big data to support quality use of medicines (#57)

Georgina A Hughes 1 2 , Maria C Inacio 2 3 , Debra Rowett 4 , Gillian E Caughey 2 3 , Tracy Air 2 , Robert N Jorissen 2 3 , Catherine Lang 2 , Megan Corlis 5 , Janet K Sluggett 1
  1. Adelaide University, College of Health, School of Allied Health and Human Performance, Adelaide, South Australia, Australia
  2. Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
  3. Registry of Senior Australians Research Centre, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
  4. Adelaide University, College of Health, School of Pharmacy and Biomedical Sciences, Adelaide, South Australia, Australia
  5. Australian Nursing & Midwifery Federation SA Branch, Adelaide, South Australia, Australia

Aims. Activities to improve psychotropic medicines use in residential aged care homes (RACHs) have largely ignored antidepressants. We aimed to examine antidepressant use and safety in RACHs to support quality use of medicines.

 

Methods. This presentation will discuss findings from four recent population-level studies conducted using linked data from a national health and aged care data platform.1-4 These studies examined national trends in antidepressant use in Australian RACHs (2006-2019), factors associated with antidepressant initiation, duration of use and discontinuation, and the risk of adverse outcomes associated with mirtazapine compared to sertraline.

 

Results. Prevalence of antidepressant use increased from 46.1% (95% confidence interval (CI) 45.9-46.4) to 58.5% (95%CI 58.3-58.8) during 2006-2019, with 20.9% (95%CI 20.7-21.1) of residents supplied mirtazapine in 2019.1 Of 34,525 new residents using an antidepressant within two months, 29,712 (86.1%) had initiated treatment in primary care or hospitals.2 The median time on therapy after entry was 503 days (interquartile range 218-871).3 New users were more likely to discontinue antidepressants compared with existing users (subdistribution hazard ratio 1.36, 95%CI 1.29-1.44).3 Mirtazapine use was associated with 16% higher risk of mortality compared to sertraline (adjusted hazard ratio 1.16, 95%CI 1.05-1.29).4

 

Conclusions. The use of routinely collected real-world data identified extensive, prolonged and potentially harmful use of antidepressants in RACHs and informed key actions for practice change to support quality use of medicines. We must carefully consider the place of antidepressants in treatment pathways, the availability of safer alternatives, and regularly review antidepressant use for safety and effectiveness in RACHs. 

  1. Hughes, GA, Inacio, MC, Rowett, D, et al. National trends in antidepressant use in Australian residential aged care facilities (2006-2019). J Am Med Dir Assoc 2024;25(6):104957. DOI: 10.1016/j.jamda.2024.01.026
  2. Hughes, GA, Inacio, MC, Rowett, D, et al. Setting of initiation and factors associated with antidepressant use on entry to long-term care facilities. Br J Clin Pharmacol 2025;91:1749-1759. DOI: 10.1111/bcp.16403
  3. Hughes, GA, Inacio, MC, Rowett, D, et al. Prolonged Use of Antidepressants Among Older People Residing in Long-Term Care Facilities. J Am Med Dir Assoc 2025;26(4):105482. DOI: 10.1016/j.jamda.2024.105482
  4. Hughes, GA, Inacio, MC, Rowett, D, et al. Risk of adverse outcomes associated with mirtazapine compared to sertraline use among older people living in long-term care facilities. Age Ageing 2025;54(4):afaf074. DOI: 10.1093/ageing/afaf074