Longitudinal prescribing patterns of psychotropic drugs in nursing home residents.

Abstract

Changes in the use of psychotropic drugs in a large nursing home were examined both in terms of usage for the total facility and in longitudinal changes within individuals. Data for the nursing home showed a gradual increase in use of antidepressants; a decrease in use of antianxiety medications and of sedative-hypnotics. Changes in the number of residents prescribed antipsychotics were not marked. Data within residents showed a great variability in number of psychotropic drugs used, in number of changes in dosage, and in specific patterns of medication change. The first drug change after admission (excluding day of admission) was more likely to involve initiation rather than discontinuation of psychotropic drugs. The medications studied were used over 4-7 months on the average, covering 20-30% of the resident's nursing home stay. The findings suggest lhat there is continued monitoring of psychotropic medications in the nursing home.

The dispensing of psychotropic medicines to older people before and after they enter residential aged care

“…Our finding that psychotropic medicine dispensing increased after people entered residential care is consistent with the findings of a study in Northern Ireland and of two smaller studies: one in Melbourne including residents of seven RACFs, and a single RACF study in the United States . Of particular concern is that 20% (antidepressants) to 46% of residents (antipsychotics) in our study first received psychotropic medicines in residential care, probably indicating non‐adherence to psychotropic medicine prescribing guidelines.…”

Disruptive Vocalization and Depression in Older Nursing Home Residents

“…We believe that this study has important implications for the management of vocally disruptive nursing home residents. The Omnibus Reconciliation Act (OBRA) of 1987, which came into effect in 1990, has altered psychotropic drug prescribing in the US and elsewhere, leading to a decrease in the extent of antipsychotic drug prescribing and a corresponding increase in the prescription of antidepressant medication (Cohen-Mansfield et al, 1996;Conn & Goldman, 1992;Rovner et al, 1992). Few would argue, however, that the OBRA has led to a situation whereby every nursing home resident who might benefit from antidepressant medication receives it in a timely fashion and at an appropriate dose.…”

Psychotropic Medications and the Transition Into Care: A National Data Linkage Study

“…18 Studies in the United States and Canada report higher averages, with approximately 25% to 30% of residents receiving antipsychotic medication, but these studies are often limited to nursing home residents. 4,13,28 Only a few studies were found that followed a cohort of older people moving into care, and these have been small and based only within a few care homes, 29,30 but they also indicate an increase in medication use on entry and show that many residents start and stop medications during their stay. Although this was not explicitly examined in the current study, the increasing proportion of residents exposed to psychotropic medicines during the 6 months after admission suggest it.…”