Antipsychotic and Benzodiazepine Use Among Nursing Home Residents: Findings From the 2004 National Nursing Home Survey

Abstract

Objectives To document the extent and appropriateness of use of antipsychotics and benzodiazepines among nursing home residents using a nationally representative survey. Methods Cross-sectional analysis of the 2004 National Nursing Home Survey. Bivariate and multivariate analyses examined relationships between resident and facility characteristics and antipsychotic and benzodiazepine use by appropriateness classification among residents aged 60 years and older (N = 12,090). Resident diagnoses and information about behavioral problems were used to categorize antipsychotic and benzodiazepine use as appropriate, potentially appropriate, or having no appropriate indication. Results More than one quarter (26%) of nursing home residents used an antipsychotic medication, 40% of whom had no appropriate indication for such use. Among the 13% of residents who took benzodiazepines, 42% had no appropriate indication. In adjusted analyses, the odds of residents taking an antipsychotic without an appropriate indication were highest for residents with diagnoses of depression (odds ratio [OR] = 1.31; 95% confidence interval [CI]: 1.12–1.53), dementia (OR = 1.82; 95% CI: 1.52–2.18), and with behavioral symptoms (OR = 1.97, 95% CI: 1.56–2.50). The odds of potentially inappropriate antipsychotic use increased as the percentage of Medicaid residents in a facility increased (OR = 1.08, 95% CI: 1.02–1.15) and decreased as the percentage of Medicare residents increased (OR = 0.46, 95% CI: 0.25–0.83). The odds of taking a benzodiazepine without an appropriate indication were highest among residents who were female (OR = 1.44; 95% CI: 1.18–1.75), white (OR = 1.95; 95% CI: 1.47–2.60), and had behavioral symptoms (OR = 1.69; 95% CI: 1.41–2.01). Conclusion Antipsychotics and benzodiazepines seem to be commonly prescribed to residents lacking an appropriate indication for their use.

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

“…In the United States [27], there is a lower use of benzodiazepines due to the safety warnings issued in the late '80 and due to specific actions tackling the high use of these drugs (Medicare part D). Another strength of this study is that our data collection was based on reliable recording from primary sources, namely medication charts and direct clinical information from the treating GP.…”

“…Previous articles indicate the need for documentation of indications to proper evaluate the appropriateness of psychotropic drug use [27,28]. Therefore, the aim of this study was to describe the prevalence of benzodiazepine use in Belgian nursing homes, with attention to indications and dosages for each of the commonly used drugs.…”

Nurses' intentions to initiate an antipsychotic or behavioral intervention with nursing home residents : the role of norms, being evaluated, self-efficacy, time pressures, and staffing.

“…Nationally representative data from 2004 found that 26% of nursing home residents were on an antipsychotic, and that 40% of the prescriptions were inappropriate (Stevenson et al, 2010). Additionally, an innovative, quasi-experimental study compared medication misuse between nursing home and assisted living residents after CMS implemented a series of new regulations in 1999 (Briesacher, Limcangco, Simoni-Wastila, Doshi, & Gurwitz, 2005a).…”

“…In order to manage NPS among nursing home residents, physicians have commonly prescribed antipsychotics (Briesacher et al, 2005b;Ray, Federspiel, & Schaffner, 1980;Stevenson et al, 2010). Although some data supports their efficacy to manage NPS (Schneider, Dagerman, & Insel, 2006a), antipsychotics are associated with accelerated cognitive decline (Vigen et al, 2011), somnolence, extrapyramidal symptoms, cerebrovascular accidents (Schneider et al, 2006a), and death (Schneider, Dagerman, & Insel, 2005) among older adults with dementia.…”

“…Epidemiological evidence suggests that up to 40% of prescribed antipsychotics are inappropriate among nursing home residents (Briesacher et al, 2005b;Stevenson et al, 2010). In order to ameliorate problematic prescribing practices, the federal government has mandated guidelines and medication reviews, and others have designed education-based programs.…”