Trends and variation in benzodiazepine use in nursing homes in the USA

Malagaris, Ioannis; Mehta, Hemalkumar B.; Goodwin, James S.

doi:10.1007/s00228-021-03244-4

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…44–53 Research also examined specific categories of medications with known potential adverse effects for older adults, such as those with a high anticholinergic burden, 54–61 anticoagulants, 62–68 antidepressants, 69–80 anti-psychotics, 31 36 44 70 77 78 81–107 or statins. 49–51 108–112 Analysis of prescribing in some medication categories - antibiotics 113–116 or benzodiazepines, 84 117 for example, may be used to make broader assumptions about quality of care. A common approach in MDS-based research has been to consider medications as risk factors for adverse events in care homes.…”

Section: Resultsmentioning

confidence: 99%

Application and content of minimum data sets for care homes: A mapping review

Hanratty,

Akdur,

Burton

et al. 2024

Preprint

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BackgroundCare home residents have complex needs, and minimum data sets (MDSs) provide a unique source of information on their health and wellbeing. Although MDSs were first developed to monitor quality and costs of care, they can make an important contribution to research.AimTo describe the research applications of data from care home MDSs, and identify key outcome variables and measures used.DesignMapping review of published empirical studies using data generated from minimum data sets in long term care facilities for older adults.MethodsWe performed a comprehensive search of electronic databases (Medline OVID, CINAHL, Embase and ASSIA), using bespoke search strategies to identify English language publications 2011 - 2024. Articles were screened by two independent reviewers. They were grouped by study topic and data (on publication date, country, MDS, outcome variables and specific items or measures) were charted without quality assessment. The key features of the data are described in a narrative synthesis.FindingsSearches identified 18588 articles published 2011-2024, of which 661 met inclusion criteria. 72% were from the USA, 12% from Canada and the remaining 16% from four European countries, South Korea and New Zealand. The studies encompassed individual resident functioning (e.g. mobility, incontinence), health conditions and symptoms (e.g. depression, pain), healthcare in the home (e.g. prescribing, end of life care), hospital attendances and admissions, transitions to and from care homes, quality of care and systemwide issues. Measures used reflected the content of the major MDSs, but there was a mismatch between the importance of some topics to care homes (e.g. incontinence) and the range of published papers, and limited consensus over how to measure quality of life.ConclusionsCare home MDSs are a unique resource to support study of care home residents and impact of interventions over time. They are a powerful resource when linked to other datasets, and as an adjunct to primary data collection This analysis may serve as an accessible guide to the content and applications of MDS, allowing researchers to consider the sort of questions that can be posed and the different components of resident care or experience that can be evaluated.

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Section: Resultsmentioning

confidence: 99%

Application and content of minimum data sets for care homes: A mapping review

Hanratty,

Akdur,

Burton

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Diagnoses captured by the RAI‐MDS 2.0 assessment were also used to identify comorbid chronic conditions potentially associated with BZD or gabapentinoid use 20,33–35 . The assessment includes diseases to be checked as present if they are related to the resident's current functional, cognitive, behavioral, treatment, or health risk status.…”

Section: Methodsmentioning

confidence: 99%

“…Diagnoses captured by the RAI-MDS 2.0 assessment were also used to identify comorbid chronic conditions potentially associated with BZD or gabapentinoid use. 20,[33][34][35] The assessment includes diseases to be checked as present if they are related to the resident's current functional, cognitive, behavioral, treatment, or health risk status. Those selected for inclusion in our analyses, based on availability, prevalence, and relevancy, were (listed alphabetically): anxiety disorders, chronic obstructive pulmonary disease (COPD), dementia, diabetes, disruption in sleep patterns, edema, missing/ amputated limbs, multiple sclerosis (MS), Parkinson's disease, peripheral vascular disease, renal failure, seizure disorder, and spinal cord injury.…”

Section: Resident Characteristicsmentioning

confidence: 99%

Trends and correlates of concurrent opioid and benzodiazepine and/or gabapentinoid use among Ontario nursing home residents

Hogan

Campitelli

Bronskill

et al. 2023

J American Geriatrics Society

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Background A concern with long‐term opioid use is the increased risk arising when opioids are used concurrently with drugs that can potentiate their associated adverse effects. The drugs most often encountered are benzodiazepines (BZDs) and gabapentinoids. Our study objectives were to examine trends in the concurrent use of opioids and BZDs, or gabapentinoids, in a Canadian nursing home population over an 11‐year period, and current resident‐level correlates of this concurrent use. Methods We conducted a population‐based, repeated cross‐sectional study among Ontario nursing home residents (>65 years) dispensed opioids between April 2009 and February 2020. For the last study year, we examined cross‐sectional associations between resident characteristics and concurrent use of opioids with BZDs or gabapentinoids. Linked data on nursing home residents from clinical and health administrative databases was used. The yearly proportions of residents who were dispensed an opioid concurrently with a BZD or gabapentinoid were plotted with percent change derived from log‐binomial regression models. Separate modified Poisson regression models estimated resident‐level correlates of concurrent use of opioids with BZDs or gabapentinoids. Results Over the study period, among residents dispensed an opioid there was a 53.2% relative decrease (30.7% to 14.4%) in concurrent BZD and a 505.4% relative increase (4.4% to 26.6%) in concurrent gabapentinoid use. In adjusted models, increasing age and worsening cognition were inversely associated with the concurrent use of both classes, but most other significantly related covariates were unique to each drug class (e.g., sex and anxiety disorders for BZD, pain severity and presence of pain‐related conditions for gabapentinoids). Conclusions Co‐administration of BZDs or gabapentinoids in Ontario nursing home residents dispensed opioids remains common, but the pattern of co‐use has changed over time. Observed covariates of concurrent use in 2019/20 suggest distinct but overlapping resident populations requiring consideration of the relative risks versus benefits of this co‐use and monitoring for potential harm.

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“…Overall, the evidence reviewed shows that regulation can have positive impacts on quality of care. In terms of structures and processes, this related in particular to requirements on minimum direct care staffing (structures) [25][26][27][28][29] , training and educational requirements [30][31][32] , medication prescribing requirements 33 , and requirements relating to restrictive practices (processes) 34 . Requirements which related to outcomes focussed mostly on healthcare such as pressure ulcers, falls, emergency department visits, and hospitalisations, with little evidence focusing on requirements on residents' rights, beliefs and satisfaction with care [35][36][37][38] .…”

Section: Introductionmentioning

confidence: 99%

The impact of regulation on the quality of care in nursing homes in Ireland: a time-series analysis of change in compliance

Behan,

Grogan,

Keyes

2024

HRB Open Res

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Background Quality in health and social care is of paramount importance. Regulation is often used for ensuring or promoting quality in care services. Services are typically regulated by independent public authorities, which monitor services for compliance with regulations. There is limited research, however, on services’ compliance with regulations to provide a high quality of care. This study aims to examine nursing home compliance with regulations relating to quality. Methods Secondary legislation used for regulating nursing homes in Ireland was mapped to the Donabedian’s quality framework with each regulation categorised as either “structure”, “process” or “outcome”. The regulations categorised as “outcome” were determined to be quality-related regulations; such regulations were extracted and became this study’s area of focus. Published inspection reports from the regulator in Ireland for a three year period (2019 to 2021) (n=1,153) were assessed. The frequency with which the “outcome regulations” were inspected in nursing homes, and the proportion of compliance achieved, was calculated. Change in compliance levels across the three years was evaluated using Chi2 tests. Results Ten regulations were categorised as “outcome regulations” and addressed the following areas: positive behaviour; protection; residents' rights; communication; visits; personal possessions; food and nutrition; information for residents; medicines and pharmaceutical services; and complaints procedures. Compliance with two regulations (‘Regulation 9: Residents’ rights’ and ‘Regulation 11: Visits’) significantly improved during the three years (p<0.05). Compliance with ‘Regulation 12: Personal Possessions’ significantly decreased over the three years, however, so did the proportion found not compliant. While there was no significant change in the other regulations examined, compliance trended towards improvement, except for one regulation, ‘Regulation 20: Information for residents’, which trended downwards. Conclusion This analysis of national-level data found improvements in compliance across nearly all quality-related regulations demonstrating that regulation can be a positive influence on quality maintenance and improvement.

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Trends and variation in benzodiazepine use in nursing homes in the USA

Cited by 5 publications

References 28 publications

Application and content of minimum data sets for care homes: A mapping review

Application and content of minimum data sets for care homes: A mapping review

Trends and correlates of concurrent opioid and benzodiazepine and/or gabapentinoid use among Ontario nursing home residents

The impact of regulation on the quality of care in nursing homes in Ireland: a time-series analysis of change in compliance

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