A study of antipsychotic drug use in nursing homes: epidemiologic evidence suggesting misuse.

Ray, Wayne A.; Federspiel, Charles F.; Schaffner, William

doi:10.2105/ajph.70.5.485

Cited by 277 publications

(141 citation statements)

References 13 publications

Supporting

Mentioning

124

Contrasting

Unclassified

Order By: Relevance

“…Social control functions of these medications include work-and sex-role socialization (Waldron 1977), custodial care of nursing home patients (Ray et al 1980), and maintenance of prisoners and juvenile delinquents (Lerman 1982). The need for quick, efficient, and costeffective solutions to the problems of mental illness is of importance only in a society where speed, efficiency, and parsimony are highly valued at the expense of humanitarian concerns.…”

Section: Resultsmentioning

confidence: 99%

Tardive Dyskinesia: Barriers to the Professional Recognition of an Iatrogenic Disease

Brown¹,

Funk²

1986

Journal of Health and Social Behavior

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 99%

Tardive Dyskinesia: Barriers to the Professional Recognition of an Iatrogenic Disease

Brown¹,

Funk²

1986

Journal of Health and Social Behavior

View full text Add to dashboard Cite

show abstract

“…The administration of antipsychotic drugs without a diagnosis of psychosis is usually regarded with suspicion by experts; misuse of antipsychotic drugs in nursing homes has long been documented in the medical and public health literature (e.g., Ray, Federspiel and Schaffner, 1980;Avorn and Gurwitz, 1995). Such drugs may be used to pacify demanding residents and free up nursing staff to care for other residents.…”

Section: Organizational Performance Datasetmentioning

confidence: 99%

Does Organization Ownership Matter? Structure and Performance in For-Profit, Nonprofit and Local Government Nursing Homes

Ben‐Ner

Ren

2008

SSRN Journal

View full text Add to dashboard Cite

We compare the structure and performance of for-profit (FP), nonprofit (NP) and local government (LG) organizations. These organizations differ in their ownership structure, objectives and agency relations. We conjecture that, compared to NP and LG, FP firms (a) delegate less decision-making power to employees, (b) provide more incentives and fewer fringe benefits, (c) monitor less, and (d) rely less on social networks to recruit employees. We also hypothesize that, relative to NP and LG, FP firms (i) are more efficient, (ii) provide similar levels of service elements that observable to their customers, (iii) provide lower levels of less-well observable elements, and (iv) provide less of the relational elements. Differences in structure and performance are likely to be tempered by regulation, market competition and institutional pressures for similarity. We study detailed performance outcomes for all the 369 Minnesota nursing homes included in federal and state datasets, and organization structure for a subsample of 105 homes that responded to our survey. Our empirical investigation generally supports our hypotheses. In particular, we find that FP homes serve more residents than NP and LG, after controlling for quality differences. However, FP homes provide lower quality services on a large array of attributes, especially those that are less observable by nursing home residents and their families. The differences among different types of organization are small, but significant. [list] who provided data and helped making sense of them. We also thank [list] who worked on the preparation and administration of the survey; nursing home administrators who responded to the survey were instrumental in the development of this project.

show abstract

“…The majority of US studies conducted in the 70s and 80s found that approximately 40% of nursing home residents were receiving neuroleptic medications (Avorn et al, 1989;Buck, 1988;Prien et al, 1975;Ray et al, 1980), with some studies finding lower rates of 26% (Beers et al, 1988) and 13% (Gilleard et al, 1983). More recent US studies in the 1990s have found rates of use varying from around 20% (Garrad et al, 1991;Llorente et al, 1998) up to 39.3% (Burton et al, 1995).…”

Section: Neuroleptic Drug Use In Nursing Homesmentioning

confidence: 99%

“…International studies report varying rates of neuroleptic use in long-term care, ranging from 44% in England (Gilleard et al, 1983), 30.7% in Australia (Snowdon & Vaughan, 1997), 24% in Scotland (McGrath & Jackson, 1996, and 17% in Canada (Earthy et al, 1999). physicians (Colenda et al, 1996), facility size (Ray et al, 1980), and nursing staff levels (Svarstad & Mount, 1991). Nevertheless, there is increasing evidence of concern, particularly in the United Kingdom, about the use of these drugs in long-term care facilities and the general lack of adequate controls and guidelines (Hughes et al, 1999;Turrell et al, 1999).…”

Section: Neuroleptic Drug Use In Nursing Homesmentioning

confidence: 99%

Neuroleptic drug use in long‐term care: An inappropriate panacea?

Hagen

Armstrong‐Esther²

2001

Quality in Ageing and Older Adults

View full text Add to dashboard Cite

Despite the increasing evidence about the inappropriate use of medications by older people, there is very little published evidence about the control and monitoring of neuroleptic drugs used in nursing homes. As others have indicated, this is all the more worrying when set in the context of the paucity of research on nursing home care and the trend to replace registered nurses with untrained care assistants. In the United States, legislation in the form of the Nursing Home Reform Act (OBRA 1987) was introduced, in part, to regulate the prescribing and administration of neuroleptic (antipsychotic) drugs. No such legislation exists in Canada or the United Kingdom. In the case of the latter jurisdiction, the recent Royal Commission on Long-Term Care for older people (The Stationery Office, 1999) has recommended a national care commission to monitor care, and set assessment and quality benchmarks. In Canada this debate has not even begun, and the purpose of this paper is not to ignite controversy, but to raise questions about the use of these drugs with nursing home residents. Voluntary guidelines and education of physicians, nurses and care attendants would be infinitely better than legislation. In the meantime, we need research to address the following questions: For what reasons should these drugs be given to older people? Are these drugs being used appropriately? Is the risk of side-effects too great with these drugs? Are the numbers and type of staff employed in nursing homes adequate/qualified to detect and report side-effects? How well do these drugs manage the behaviours they are given lo control? Are they being used as chemical restraints or to make the older person compliant? Are the so-called 'atypical' neuroleptic drugs any better? What we offer in this article is background information that might encourage others to not only review their practice but also to address these questions.

show abstract

A study of antipsychotic drug use in nursing homes: epidemiologic evidence suggesting misuse.

Abstract: We reviewed 384,326 prescriptions for 5,902 Medicaid patients residing continuously for one year in 173 Tennessee nursing homes. Of these pa-

Cited by 277 publications

References 13 publications

Tardive Dyskinesia: Barriers to the Professional Recognition of an Iatrogenic Disease

Tardive Dyskinesia: Barriers to the Professional Recognition of an Iatrogenic Disease

Does Organization Ownership Matter? Structure and Performance in For-Profit, Nonprofit and Local Government Nursing Homes

Neuroleptic drug use in long‐term care: An inappropriate panacea?

Contact Info

Product

Resources

About