ANTIPSYCHOTICS AND OTHER PSYCHOPHARMACOLOGICAL MEDICATION USE IN UNITED STATES NURSING HOMES: WHAT ARE THE CONCERNS AND ACTIONS TAKING PLACE TO OPTIMIZE PRESCRIBING?

Abstract

Historically, the use of psychopharmacological medications (PPMs), such as antipsychotics, antidepressants, sedative-hypnotics and anxiolytics, has been scrutinized due to concerns with safety and efficacy especially in older adults with dementia. In 2012, the Centers for Medicare and Medicaid Services (CMS) launched a National Initiative to improve the behavioral health of older adults residing in America's Nursing Homes with a focus on reducing the inappropriate use of antipsychotics. This is in addition to the Unnecessary Medication Guidance (F329) that is utilized by surveyors to look at all medications for indication, dose, duration and monitoring for efficacy and adverse consequences. The intent of this presentation is to describe the use of psychopharmacological medications in nursing homes (NHs) and relate it to the ongoing initiatives to improve the care of persons with dementia. In order to estimate the prevalence and patterns of use of psychopharmacological medications (PPMs) a 5% random sample of 2007 Medicare claims data (Parts A, B and D claims) linked to the Minimum Data Set 2.0. This is a cross sectional study of a nationally representative sample of 69, 832 NHs residents with > 3 months of institutionalization. The study measured one-year prevalence and quality of PPM use and operationalized the indication, dose, and duration of use according to the current CMS guidance and practice guidelines. Dose exposure was operationalized with a modified standardized daily dose (mSDD). There were over two-thirds of residents using > 1 PPM and most using them for greater than half of the year. Among antipsychotic users, the indication for use was chronic psychiatric conditions (49.9%); Alzheimer's Disease and Related Dementia with behavioral symptoms (61.6%) and Delirium (20.7%). The mean days of use for each of the indications respectively were 214, 215 and 190 with 71-92% of the residents on a mSDD within acceptable range. These national estimates provide a benchmark to look at the chronic use of all psychopharmacological medications among long stay nursing home residents. Furthermore, in light of the increased focus on antipsychotics it highlights that prescribing of other psychopharmacologicals should not be ignored.