A retrospective, longitudinal study of factors associated with new antipsychotic medication use among recently admitted long-term care residents.

Andrea Foebel,Koen Milisen,Nathalie Ih Wellens,Rosa Liperoti,John P Hirdes,Anna Ballokova,Daniela Fialova

doi:10.1186/s12877-015-0127-8

Abstract

BackgroundUse of antipsychotic (AP) medications is high and often inappropriate among institutionalized populations. Little is known about the correlates of new AP drug use following admission to long-term care (LTC) settings. This study investigated the frequency and correlates of new AP drug use among newly admitted LTC residents.MethodsThis longitudinal, retrospective study used data from the interRAI - Nursing Home Minimum Data Set version 2.0 (MDS 2.0) instrument. Data about demographic, clinical and social characteristics, and medication use, were collected in Ontario, Canada, from 2003–2011 by trained nurses. Residents with complete admission and 3–6 month follow-up data were included (N = 47,768). Multivariate logistic regression analyses, stratified by gender, explored correlates of new AP drug use upon admission to LTC.ResultsNew AP drug users comprised 7 % of the final cohort. Severe cognitive impairment, dementia, and motor agitation were significantly associated with new AP drug use among both sexes. Additionally, behavioural problems, conflicts with staff and reduced social engagement were strong correlates of new AP drug use.ConclusionsSocial factors were as strongly associated with new AP drug use after LTC admission as clinical factors. Strategies to prevent the potential misuse of AP drugs upon LTC admission should consider the social determinants of such prescribing.

Highlights

Use of antipsychotic (AP) medications is high and often inappropriate among institutionalized populations
Follow-up assessments within 180 days of the admission time were included, but most follow-ups were completed around 90 days in accordance with facility protocols
While the current study found a much lower rate (7 %), it may be because AP drug use is more pervasive in both community and institutional settings in the North American context or alternately, that shorter-term AP use was not captured between assessments

Summary

Introduction

Use of antipsychotic (AP) medications is high and often inappropriate among institutionalized populations. This study investigated the frequency and correlates of new AP drug use among newly admitted LTC residents. Despite being approved for indications such as schizophrenia and bipolar disorder, antipsychotic (AP) drugs are prescribed off-label for numerous clinical conditions and disorders and are commonly used to treat the behavioural and psychiatric symptoms of dementia (BPSD) [1,2,3]. Irreversible clinical syndrome, affecting 35.6 million people worldwide [4]. It is characterized by widespread decline in AP drugs are commonly prescribed to reduce BPSD despite the lack of evidence about their efficacy, high placebo responses and serious adverse events [9,10,11]. Studies have shown that as much as 80 % of this use is among residents without a diagnosis of severe mental illness [15, 16, 18]

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