Document Detail

Use of antipsychotics among older residents in VA nursing homes.
MedLine Citation:
PMID:  23047785     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Antipsychotic medications are commonly prescribed to nursing home residents despite their well-established adverse event profiles. Because little is known about their use in Veterans Affairs (VA) nursing homes [ie, Community Living Centers (CLCs)], we assessed the prevalence and risk factors for antipsychotic use in older residents of VA CLCs.
METHODS: This cross-sectional study included 3692 Veterans age 65 or older who were admitted between January 2004 and June 2005 to one of 133 VA CLCs and had a stay of ≥90 days. We used VA Pharmacy Benefits Management data to examine antipsychotic use and VA Medical SAS datasets and the Minimum Data Set to identify evidence-based indications for antipsychotic use (eg, schizophrenia, dementia with psychosis). We used multivariable logistic regression and generalized estimating equations to identify factors independently associated with antipsychotic receipt.
RESULTS: Overall, 948/3692(25.7%) residents received an antipsychotic, of which 59.3% had an evidence-based indication for use. Residents with aggressive behavior [odds ratio (OR)=2.74, 95% confidence interval (CI), 2.04-3.67] and polypharmacy (9+ drugs; OR=1.84, 95% CI, 1.41-2.40) were more likely to receive antipsychotics, as were users of antidepressants (OR=1.37, 95% CI, 1.14-1.66), anxiolytic/hypnotics (OR=2.30, 95% CI, 1.64-3.23), or drugs for dementia (OR=1.52, 95% CI, 1.21-1.92). Those residing in Alzheimer/dementia special care units were also more likely to receive an antipsychotic (OR=1.66, 95% CI, 1.26-2.21). Veterans with dementia but no documented psychosis were as likely as those with an evidence-based indication to receive an antipsychotic (OR=1.10, 95% CI, 0.82-1.47).
CONCLUSIONS: Antipsychotic use is common among VA nursing home residents aged 65 and older, including those without a documented evidence-based indication for use. Further quality improvement efforts are needed to reduce potentially inappropriate antipsychotic prescribing.
Walid F Gellad; Sherrie L Aspinall; Steven M Handler; Roslyn A Stone; Nicholas Castle; Todd P Semla; Chester B Good; Michael J Fine; Maurice Dysken; Joseph T Hanlon
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Medical care     Volume:  50     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-10     Completed Date:  2013-01-07     Revised Date:  2013-10-31    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  954-60     Citation Subset:  IM    
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive, Pittsburgh, PA 15206, USA.
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MeSH Terms
Aged, 80 and over
Anti-Anxiety Agents / administration & dosage
Antidepressive Agents / administration & dosage
Antipsychotic Agents / administration & dosage*
Cross-Sectional Studies
Dementia / drug therapy
Drug Utilization / statistics & numerical data*
Health Status
Homes for the Aged / statistics & numerical data*
Nursing Homes / statistics & numerical data*
Socioeconomic Factors
United States
United States Department of Veterans Affairs / statistics & numerical data*
Grant Support
3U01 AG012553/AG/NIA NIH HHS; K07 AG033174/AG/NIA NIH HHS; K07AG033174/AG/NIA NIH HHS; P30 AG024827/AG/NIA NIH HHS; P30AG024827/AG/NIA NIH HHS; R01 AG027017/AG/NIA NIH HHS; R01 AG034056/AG/NIA NIH HHS; R01 NR010135/NR/NINR NIH HHS; R01AG034056/AG/NIA NIH HHS; R34 MH082682/MH/NIMH NIH HHS; R56 AG027017/AG/NIA NIH HHS; R56AG027017/AG/NIA NIH HHS; T32 AG021885/AG/NIA NIH HHS
Reg. No./Substance:
0/Anti-Anxiety Agents; 0/Antidepressive Agents; 0/Antipsychotic Agents

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