Mental Illness and Psychotropic Medication Use in the Nursing Home

Abstract

The authors examined mental illness and psychotropic medications use among nursing home residents. Data were drawn from the Texas Long-Term Care Reimbursement Project, a 1986 study of nearly 2,000 residents in 49 nursing homes. The study measured the use of antipsychotics and other psychotropic medications, physical health conditions, mental illness diagnoses, behavior, and nursing and other direct-care time for sampled residents. The findings indicated that 45% of the sample was receiving an antipsychotic or other psychotropic medication. Although psychotropics were prescribed more extensively for those with a psychiatric diagnosis, nearly one half of persons without a psychiatric diagnosis were receiving psychotropic medications at the time of the survey. Moreover, psychotropics were quite prevalent among those with unstable medical conditions and/or severe activities of daily living impairment. Neither a mental illness diagnosis, evidence of a behavioral problem, nor use of psychotropics was significantly correlated with the amount of nursing or other direct-care time received by residents. The findings raise concerns about the widespread prescribing of these medications, especially among residents who have no supporting psychiatric diagnosis and/or who have physical health conditions making them vulnerable to adverse drug effects.

Determinants for the use of psychotropics among nursing home residents

“…Accordingly, a psychiatric diagnosis was not a general independent determinant of the use of psychotropics, if a determinant at all. Other studies have also documented that only a minor proportion of those receiving psychotropics have a supporting psychiatric diagnosis (Burns and Kamerow, 1988;Arling et al, 1991;Beardsley et al, 1989).…”

“…Furthermore, the sta members were asked to give their assessment of the residents' mental status (dementia or other brain disorder, depression, other than depression and dementia, unknown and mentally well). Doane et al (1989) 4571 20 Thacker and Jones (1997) 382 23 Morgan et al (1982) 1122 34 Nygaard et al (1990) 1284 33 Beardsley et al (1989) 526 35 McGrath and Jackson (1996) 909 24 Studies on all psychotropics Arling et al (1991) The sta informant for a particular resident was the primary caregiver or one with similar knowledge of the resident, as selected by the other sta members. One hundred and eighteen sta members (median age 43 years) participated.…”

“…Some of the most frequently prescribed drugs in nursing homes are psychotropics, with a large proportion of residents receiving at least one psychotropic (Gilleard et al, 1983;Doane et al, 1989;Thacker and Jones, 1997;Morgan et al, 1982;Nygaard et al, 1990;Beardsley et al, 1989;McGrath and Jackson, 1996;Arling et al, 1991;Snowdon et al, 1995;Burns and Kamerow, 1988;Kholy et al, 1994;Tybjerg and Gulmann, 1992) (Table 1). Frequent use of psychotropics increases the risk of drug-related adverse events, which now constitute a public health problem of considerable magnitude (Monette et al, 1995).…”

Medication use in nursing homes for elderly people

“…Garrard et al (1991) con®rmed that in nursing homes, the documentation of reasons for prescribing neuroleptic drugs is poor. Arling et al (1991) showed that 37% of their sample had no mental illness or behaviour problems but were taking antipsychotics.…”

The Use of Medicines with Anticholinergic Effects in Older People: A Population Study in an Urban Area of Sweden

“…Other investigators have not presented the overall use of this group of medicines. However, if we compare the sums of the use of neuroleptics and tricyclic antidepressants in nursing homes in the present material with these studies taken together, 1,3,4,29–31 our figures are similar or lower.…”