Trends in Antipsychotic and Mood Stabilizer Prescribing in Long-Term Care in the U.S.: 2011–2014

Gerlach, Lauren B.; Kales, Helen C.; Kim, Hyungjin Myra; Bynum, Julie; Chiang, Claire; Strominger, Julie; Maust, Donovan T.

doi:10.1016/j.jamda.2020.05.039

Cited by 30 publications

(33 citation statements)

References 28 publications

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“…Previous studies have demonstrated that declines in antipsychotic prescribing in NH have been largely matched by increases and substitution with other psychotropic medication prescribing, such as mood stabilizers 11,12 . Our study adds that this increase in mood stabilizer/anticonvulsant prescribing also occurred in AL residents with ADRD with parallel increases in prescribing during 2010–2017 among LSNH residents with ADRD.…”

Section: Discussionsupporting

confidence: 59%

Psychotropic medication prescribing in assisted living and nursing home residents with dementia after the National Partnership

Coe

Zhang

Zullo

et al. 2022

J American Geriatrics Society

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Background The Centers for Medicare & Medicaid Services implemented the National Partnership to Improve Dementia Care in Nursing Homes (the Partnership) to decrease antipsychotic use and improve care for nursing home (NH) residents with dementia. We determined whether the extent of antipsychotic and other psychotropic medication prescribing in AL residents with dementia mirrored that of long‐stay NH (LSNH) residents after the Partnership. Methods Using a 20% sample of fee‐for‐service Medicare beneficiaries with Part D, we conducted a retrospective cohort study including AL and LSNH residents with dementia. The monthly prevalence of psychotropic medication prescribing (antipsychotics, antidepressants, anxiolytics/sedative‐hypnotics, anticonvulsants/mood stabilizers, benzodiazepines, and antidementia medications) was examined. We used an interrupted time‐series analysis to compare medication prescribing before (July 1, 2010–March 31, 2012) and after (April 1, 2012–December 31, 2017) the Partnership in both settings. Results We identified 107,931 beneficiaries with ≥1 month as an AL resident and 323,766 beneficiaries with ≥1 month as a LSNH resident with dementia, including 1,923,867 person‐months and 4,984,405 person‐months, respectively. Antipsychotic prescribing declined over the study period in both settings. After the launch of the Partnership, the rate of decline in antipsychotic prescribing slowed in AL residents with dementia (slope change = 0.03 [95% CLs: 0.02, 0.04]) while the rate of decline in antipsychotic prescribing increased in LSNH residents with dementia (slope change = −0.12 [95% CLs: −0.16, −0.08]). Antidepressants were the most prevalent medication prescribed, anticonvulsant/mood stabilizer prescribing increased, and anxiolytic/sedative‐hypnotic and antidementia medication prescribing declined. Conclusions The federal Partnership to reduce antipsychotic prescribing in NH residents did not appear to affect antipsychotic prescribing in AL residents with dementia. Given the increase in the prescribing of mood stabilizers/anticonvulsants that occurred after the launch of the Partnership, monitoring may be warranted for all psychotropic medications in AL and NH settings.

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Section: Discussionsupporting

confidence: 59%

Psychotropic medication prescribing in assisted living and nursing home residents with dementia after the National Partnership

Coe

Zhang

Zullo

et al. 2022

J American Geriatrics Society

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“…For the haloperidol NICE carbamazepine, and particularly gabapentin prescription rates increased as antipsychotics decreased. 20,21 Such prescribing of antidepressants is part of the common polypharmacy seen in people with dementia in the community. 22 Mirtazapine, a noradrenergic and specific serotonergic antidepressant, is widely used in older people; from 2009 to 2014, in a study of 4•8 million antidepressant initiations in Europe, it was the antidepressant most commonly prescribed for older people and those with dementia.…”

Section: Implications Of All the Available Evidencementioning

confidence: 99%

Study of mirtazapine for agitated behaviours in dementia (SYMBAD): a randomised, double-blind, placebo-controlled trial

Banerjee¹,

High²,

Stirling³

et al. 2021

The Lancet

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Background Agitation is common in people with dementia and negatively affects the quality of life of both people with dementia and carers. Non-drug patient-centred care is the first-line treatment, but there is a need for other treatment when this care is not effective. Current evidence is sparse on safer and effective alternatives to antipsychotics. We assessed the efficacy and safety of mirtazapine, an antidepressant prescribed for agitation in dementia. MethodsThis parallel-group, double-blind, placebo-controlled trial-the Study of Mirtazapine for Agitated Behaviours in Dementia trial (SYMBAD)-was done in 26 UK centres. Participants had probable or possible Alzheimer's disease, agitation unresponsive to non-drug treatment, and a Cohen-Mansfield Agitation Inventory (CMAI) score of 45 or more. They were randomly assigned (1:1) to receive either mirtazapine (titrated to 45 mg) or placebo. The primary outcome was reduction in CMAI score at 12 weeks. This trial is registered with ClinicalTrials.gov, NCT03031184, and ISRCTN17411897.

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“…Limited national data as well as pilot studies from Virginia suggest that, while such medications targeted by reduction efforts are being used less, the prescribing of mood stabilizing antiepileptic drugs is increasing (Gerlach et al, 2020; Kerns, Winter, Winter, Boyd, et al, 2018; Kerns, Winter, Winter, Kerns, et al, 2018; Maust et al, 2018). Though the explanation for these two clinically meaningful trends remains unknown, qualitative assessments suggest that they are connected, namely, that mood stabilizers are being purposefully prescribed as unmonitored alternatives to the antipsychotics targeted by reduction measures (Kerns, Winter, Winter, Boyd, et al, 2018; Kerns, Winter, Winter, Kerns, et al, 2018).…”

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Long-Stay Mood Stabilizer Use Increasing as Prescription of Antipsychotics Decreases

et al. 2023

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Abstract. This retrospective cohort analysis of claims data used logistic regression to evaluate change in antipsychotic and antiepileptic mood stabilizer prescription frequencies in Virginia nursing homes among residents with and without seizure-epilepsy between the years 2011 and 2016. Over that period, prescription of antipsychotics decreased 13.1% to 5.6% in the long-stay population, while the use of antiepileptic mood stabilizers increased significantly 27.0%, to an 8.6% prevalence rate. These gains were entirely among residents without epilepsy. African-Americans and males were at significantly increased risk for the prescription of mood stabilizers. Growth in long-stay antiepileptic mood stabilizer use is unrelated to seizure-epilepsy, as these changes in prescription occurred only among residents without seizure-epilepsy. More antiepileptic mood stabilizers are now being prescribed to nursing-home residents without epilepsy than antipsychotics in the nursing-home population overall.

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Trends in Antipsychotic and Mood Stabilizer Prescribing in Long-Term Care in the U.S.: 2011–2014

Cited by 30 publications

References 28 publications

Psychotropic medication prescribing in assisted living and nursing home residents with dementia after the National Partnership

Psychotropic medication prescribing in assisted living and nursing home residents with dementia after the National Partnership

Study of mirtazapine for agitated behaviours in dementia (SYMBAD): a randomised, double-blind, placebo-controlled trial

Long-Stay Mood Stabilizer Use Increasing as Prescription of Antipsychotics Decreases

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