Citation

Gellad WF, Aspinall SL, Handler SM, Stone RA, Castle N, Semla TP, Good CB, Fine MJ, Dysken M, Hanlon JT. Med. Care. 2012; 50(11): 954-960.

Affiliation

*Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System †Department of Medicine (General Medicine), University of Pittsburgh ‡The University of Pittsburgh Geriatric Pharmaceutical and Gero-Informatics Research and Training Program §RAND Corporation, Pittsburgh, PA ∥Pharmacy Benefits Management Services, U.S. Department of Veterans Affairs, Hines, IL ¶School of Pharmacy #Department of Biomedical Informatics, University of Pittsburgh **Pittsburgh VA Geriatric Research, Education, and Clinical Center ††Department of Medicine (Geriatrics) ‡‡Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA §§Departments of Medicine and Psychiatry and Behavioral Sciences, The Feinberg School of Medicine, Northwestern University, Chicago, IL ∥∥Minneapolis VA Geriatric Research, Education, and Clinical Center, Minneapolis, MN.

Copyright

(Copyright © 2012, American Public Health Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/MLR.0b013e31825fb21d

PMID

23047785

Abstract

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.

Language: en