USE OF ANTIDEPRESSANTS IN U.S. NURSING HOME RESIDENTS: A SYSTEMATIC REVIEW

Abstract

AbstractAppropriate use of antidepressants can be effective in managing late-life depression, which affects nearly half of U.S. nursing home residents. Following the PRISMA guidelines, we conducted a systematic review of the literature [PubMed, Ovid PsycINFO (1967 - present), CINAHL, Web of Science, Scopus and JSTOR] to identify original research on the prevalence of antidepressant use including sub-optimal use and resident- and facility-level factors associated with use among U.S. nursing home residents. Eligible studies were peer-reviewed, observational studies, which examined antidepressant use in U.S. nursing homes. From 183 full-text reviews, we identified 19 eligible studies that covered antidepressant prevalence from 1992 to 2012. The prevalence of nursing home antidepressant use ranged from 21.9% to 54.7% of all residents, and 55.0%-82.8% of residents with depression, with higher prevalence reported in more recent studies. Over half of residents with depression took selective serotonin reuptake inhibitors (SSRI), making this the most commonly used antidepressant category. Older age, non-White race/ethnicity, not married, comorbid schizophrenia or bipolar disorder, total physical functioning dependence, and severe cognitive impairment were consistent across studies as indicators for lower odds of antidepressant use. Definitions of suboptimal antidepressant use varied across studies. In the six studies that examined the prevalence of suboptimal antidepressant use, underuse (5.1%-57.0%), overuse (42.3%), and potentially inappropriate antidepressant use (3.4%-43.1%) were reported. In conclusion, the past two decades saw an increasing trend of U.S. nursing home antidepressant use but information on the quality of antidepressant use is limited.