The Prevalence and Factors Associated with Antiepileptic Drug Use in US Nursing Home Residents

Zhao, Danni; Shridharmurthy, Divya; Alcusky, Matthew; Yuan, Yasheng; Nunes, Anthony P.; Hume, Anne L.; Baek, Jonggyu; Lapane, Kate L.

doi:10.1007/s40266-019-00732-2

Cited by 9 publications

(23 citation statements)

References 38 publications

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“…Consistent with previous research, we found that opioid use was common [36], as was use of gabapentinoids [37,38]. With increased severity of pain, we see increased use of combination therapies, suggesting that nursing homes often aggressively attempt to manage pain.…”

Section: Discussionsupporting

confidence: 87%

Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain

Lapane

Hume

Morrison

et al. 2020

Eur J Clin Pharmacol

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Objective We estimated the use of prescribed analgesics and adjuvants among nursing home residents without cancer who reported pain at their admission assessment, in relation to resident-reported pain severity. Methods Medicare Part D claims were used to define 3 classes of analgesics and 7 classes of potential adjuvants on the 21st day after nursing home admission (or the day of discharge for residents discharged before that date) among 180,780 residents with complete information admitted between January 1, 2011 and December 9, 2016, with no cancer diagnosis. Results Of these residents, 27.9% reported mild pain, 46.6% moderate pain, and 25.6% reported severe pain. The prevalence of residents in pain without Part D claims for prescribed analgesic and/or adjuvant medications was 47.3% among those reporting mild pain, 35.7% among those with moderate pain, and 24.8% among those in severe pain. Among residents reporting severe pain, 33% of those ≥ 85 years of age and 35% of those moderately cognitively impaired received no prescription analgesics/ adjuvants. Use of all classes of prescribed analgesics and adjuvants increased with resident-reported pain severity, and the concomitant use of medications from multiple classes was common. Conclusion Among nursing home residents with recognized pain, opportunities to improve the pharmacologic management of pain, especially among older residents, and those living with cognitive impairments exist. Keywords Nursing homes. Pain. Analgesics. Pain severity Keypoints • Nursing home residents commonly experience pain. • Medication management of pain could be improved as one in four residents in severe pain received no pain medications or adjuvants to pain medications.

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Section: Discussionsupporting

confidence: 87%

Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain

Lapane

Hume

Morrison

et al. 2020

Eur J Clin Pharmacol

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“…Beyond psychotropics, 19 , 20 , 21 , 22 other therapies of interest that have yet to be investigated in this population include opioids, anticonvulsants, and antibiotics. 20 , 23 , 24 , 25 , 26 In addition, the initial widespread media reports about the potential risks of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in relation to COVID-19 may have temporarily altered prescribing patterns for these agents among older residents 27 , 28 , 29 , 30 despite subsequent evidence against these early claims. 31 , 32 , 33 , 34 A recent US study 35 reported an initial peak in prescription dispensations from March 15 to 21, 2020, followed by a drop for several medications (including antibiotics), although dispensations declined less and remained more stable for ACE inhibitors and ARBs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada

et al. 2021

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Key Points Question How are COVID-19 and related disruptions in care associated with changes in the dispensation of medications commonly used among nursing home residents? Findings In this population-based cohort study with an interrupted time-series analysis of all nursing home residents from the 630 facilities in Ontario, Canada, the emergence of the COVID-19 pandemic was associated with significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids and no meaningful changes in the use of antibiotics or selected cardiovascular medications. Meaning The finding of increased use of medications with the potential for adverse effects among nursing home residents during the initial wave of the pandemic warrants ongoing monitoring for prescribing appropriateness and related resident outcomes.

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“…In five cross-sectional cohorts of all residents aged ≥ 65 years in any Medicare/Medicaid-certified nursing home in the USA (2003–2007), scores for activities of daily living, frailty, and cognition were worse in individuals with epilepsy and seizure than in those without this diagnosis [ 6 ]. In a cross-sectional study among long-stay older residents who enrolled in fee-for-service Medicare and lived in nursing homes in the USA in 2016, comorbidities among ASD users included depression, cognitive impairment, Alzheimer’s disease or dementia, diabetes, anxiety, or stroke [ 21 ]. Stroke in particular has a strong association with epilepsy/seizure risk, as individuals with stroke have 2.1-fold higher risk for epilepsy/seizure than those without stroke, and there is a strong decreasing association with age (65- to 74-year-olds had higher odds than those aged 85+ years in those with and without stroke) [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Data describing ASD use in the LTC setting are limited [ 7 , 19 ]. In the USA, approximately 10–24% of nursing home residents receive ASDs, with phenytoin and gabapentin among the most widely used [ 7 , 20 , 21 ]. Proper selection of ASDs is essential and should be based on severity of epilepsy, type and cause of seizures, and presence of coexisting medical conditions [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…Proper selection of ASDs is essential and should be based on severity of epilepsy, type and cause of seizures, and presence of coexisting medical conditions [ 22 ]. ASD users in nursing homes have significant comorbidities, including anxiety, depression, and diabetes [ 21 ]. In elderly individuals, ASDs may increase the risk of falls, cognitive side effects, and drug interactions [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Healthcare Resource Utilization Among Patients with Focal Seizures Treated with Eslicarbazepine Acetate in the US Long-Term Care Setting: A Retrospective Claims Database Analysis

Mehta¹,

Shah²,

Desai³

et al. 2021

Neurol Ther

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Introduction:The aim of this study was to compare healthcare resource utilization (HCRU) before and after initiation of eslicarbazepine acetate (ESL) in the long-term care (LTC) setting (rehabilitation center, mental health center, LTC non-skilled nursing facility/assisted-living facility, home health, assisted living, nursing home, other/unknown). Methods: This retrospective analysis used IQVIA's New Data Warehouse, which includes deterministically linked LTC, prescription, and professional fee claims data and IQVIA Hospital Charge Data Master database. The study period was 1 April 2013 to 31 December 2019. The index date was the date of ESL initiation in the LTC setting. Inclusion criteria were: (1) C 1 new ESL prescription between 1 April 2014 and 31 December 2018; (2) diagnosis of focal seizure (FS) during the 12 months pre-index date; and (3) no ESL prescription during the 12-month period pre-index. A 12-month prepost analysis compared epilepsy-specific and all-cause HCRU before and after ESL initiation. Categorical variables were compared with McNemar's tests. Results: A total of 307 patients (mean age 52.2 years, 57.7% male) with FS were included, of whom 24.8% were in nursing homes. Patients used a mean of 3.1 antiseizure drugs prior to initiation of ESL, and 87.9% of patients initiated ESL as adjunctive treatment. There were significant reductions in proportion of patients with epilepsy specific physician office visits, emergency department (ED) visits, hospitareductions in the number of epillizations, and all-cause physician office visits and hospitalizations in the post-index period compared to the pre-index period (P \ 0.05). Similar results were observed in sensitivity (patients with an epilepsy diagnosis) and subgroup analyses [presence or absence of intellectual developmental disorders or age (C 65 and \ 65 years)]. Conclusion: Proportion of patients with epilepsy-specific physician office visits, ED visits, hospitalizations, and all-cause physician office visits and hospitalizations were significantly reduced following initiation of ESL in patients with FS in LTC.

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The Prevalence and Factors Associated with Antiepileptic Drug Use in US Nursing Home Residents

Cited by 9 publications

References 38 publications

Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain

Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain

Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada

Healthcare Resource Utilization Among Patients with Focal Seizures Treated with Eslicarbazepine Acetate in the US Long-Term Care Setting: A Retrospective Claims Database Analysis

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