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Medical Care:
doi: 10.1097/MLR.0b013e31825fb21d
Original Articles

Use of Antipsychotics Among Older Residents in VA Nursing Homes

Gellad, Walid F. MD, MPH*,†,‡,§; Aspinall, Sherrie L. PharmD*,‡,∥,¶; Handler, Steven M. MD, PhD*,‡,#,**,††; Stone, Roslyn A. PhD*,‡‡; Castle, Nicholas PhD‡‡; Semla, Todd P. PharmD∥,§§; Good, Chester B. MD*,†,∥; Fine, Michael J. MD*,†; Dysken, Maurice MD∥∥; Hanlon, Joseph T. PharmD*,‡,**,††,∥∥

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Background: Antipsychotic medications are commonly prescribed to nursing home residents despite their well-established adverse event profiles. Because little is known about their use in Veterans Affairs (VA) nursing homes [ie, Community Living Centers (CLCs)], we assessed the prevalence and risk factors for antipsychotic use in older residents of VA CLCs.

Methods: This cross-sectional study included 3692 Veterans age 65 or older who were admitted between January 2004 and June 2005 to one of 133 VA CLCs and had a stay of ≥90 days. We used VA Pharmacy Benefits Management data to examine antipsychotic use and VA Medical SAS datasets and the Minimum Data Set to identify evidence-based indications for antipsychotic use (eg, schizophrenia, dementia with psychosis). We used multivariable logistic regression and generalized estimating equations to identify factors independently associated with antipsychotic receipt.

Results: Overall, 948/3692(25.7%) residents received an antipsychotic, of which 59.3% had an evidence-based indication for use. Residents with aggressive behavior [odds ratio (OR)=2.74, 95% confidence interval (CI), 2.04–3.67] and polypharmacy (9+ drugs; OR=1.84, 95% CI, 1.41–2.40) were more likely to receive antipsychotics, as were users of antidepressants (OR=1.37, 95% CI, 1.14–1.66), anxiolytic/hypnotics (OR=2.30, 95% CI, 1.64–3.23), or drugs for dementia (OR=1.52, 95% CI, 1.21–1.92). Those residing in Alzheimer/dementia special care units were also more likely to receive an antipsychotic (OR=1.66, 95% CI, 1.26–2.21). Veterans with dementia but no documented psychosis were as likely as those with an evidence-based indication to receive an antipsychotic (OR=1.10, 95% CI, 0.82–1.47).

Conclusions: Antipsychotic use is common among VA nursing home residents aged 65 and older, including those without a documented evidence-based indication for use. Further quality improvement efforts are needed to reduce potentially inappropriate antipsychotic prescribing.

© 2012 Lippincott Williams & Wilkins, Inc.


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