Analysis of post-discharge outcomes demonstrates that trazodone significantly reduces both rehospitalization rates and all-cause mortality compared to atypical antipsychotics when treating delirium symptoms in elderly patients. This finding challenges current prescribing patterns where antipsychotics remain first-line despite mounting safety concerns. The mortality advantage is particularly noteworthy given that delirium affects up to 50% of hospitalized older adults and often persists after discharge, creating a vulnerable population requiring careful medication selection. This research adds crucial real-world evidence to earlier studies suggesting antipsychotics may increase cardiovascular and metabolic risks in elderly patients. For clinicians managing post-hospital delirium, trazodone's dual mechanism—serotonin antagonism with mild sedation—appears to provide symptom control without the metabolic disruption and movement disorders associated with dopamine blockade. The safety margin becomes especially relevant for frail elderly patients already at elevated mortality risk. While the study design and population characteristics warrant examination, these outcomes suggest a potential shift away from antipsychotic-heavy protocols could meaningfully improve survival rates in this high-risk demographic.