Prevalence of epilepsy/seizures as a comorbidity of neurologic disorders in nursing homes

Birnbaum, Angela K.; Leppik, Ilo E.; Svensden, Kenneth; Eberly, Lynn E.

doi:10.1212/wnl.0000000000003629

Cited by 29 publications

(19 citation statements)

References 38 publications

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“…The number of elderly patients in the United States is rapidly increasing and is projected to be 71 million by 2030 [2]. The prevalence of epilepsy is higher in elderly nursing home residents than in any other cohort, with the point prevalence of an ICD-9 epilepsy/seizure code present in 7.8% of all elderly home nursing residents in the USA during 2007 [3]. Information regarding the patterns of antiseizure drug (ASD) use in this population is limited, and most of the available data is from studies reported more than a decade ago.…”

Section: 0 Introductionmentioning

confidence: 99%

Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents

Bathena

Leppik

Kanner

2017

Epilepsy & Behavior

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Objective The incidence of epilepsy is highest in the elderly and the prevalence of epilepsy is higher in nursing home residents than in other cohorts. Co-medications that act in the central nervous system (CNS) are frequently prescribed in this population. The objective was to identify the most commonly prescribed antiseizure drugs (ASDs) and determine the frequency of use of antipsychotic and antidepressant medications in elderly nursing home residents receiving ASDs. Methods Data were obtained from a pharmacy database serving 18,752 patients in Minnesota and Wisconsin nursing homes. Prescribing information was available on ASD, antidepressant and antipsychotic drugs on one day in October 2013. The frequency distribution by age, formulation, trademarked/generic drugs, route of administration, and multiple drug combinations were determined. Results Overall, 66.8% of 18,752 residents received at least one CNS-active drug as classified by the Generic Product Identifier classification system. For those 65 years and older, ASDs were prescribed for 14.3% residents. Gabapentin comprised 7.3%; valproate 3.0%; levetiracetam 1.8%; and phenytoin 0.9%. An antidepressant was used in 64.2% of persons prescribed an ASD. Antidepressant use varied for specific ASDs and ranged from 50 to 75%. An antipsychotic medication was used in 30% of persons prescribed an ASD and ranged from 16.8 to 54.2% for specific ASDs. Both antidepressant and antipsychotic use occurred in 22.2% of persons prescribed an ASD, respectively. Significance The pattern of CNS-active drug use has changed from previous years in this geographic region. Use of phenytoin has declined markedly, but antidepressant use has increased substantially. The CNS side effect profile of these medications and the possible long-term consequences in this population can greatly complicate therapy in these individuals.

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Section: 0 Introductionmentioning

confidence: 99%

Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents

Bathena

Leppik

Kanner

2017

Epilepsy & Behavior

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“…Interestingly, the participants from studies in this review were not gathered from nursing homes. However, the prevalence of epilepsy in older adults living in nursing homes is higher compared to communitydwelling older adults [46]. Birmbaun found that nursing home residents with epilepsy had poorer scores for activities of daily living, cognition and comorbidity burden.…”

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confidence: 99%

The quality of life of older adults with epilepsy: A systematic review

Baranowski

2018

Seizure

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The aim of this systematic review is to identify and synthesise the current literature on the quality of life (QoL) of older adults with epilepsy. Studies were included if they (1) assessed the QoL of older adults (2) had a minimum of one population group of people with epilepsy aged 60 and older and (3) used a standardised QoL measure. Databases searched were PubMed, Scopus, Cochrane Library and PubPsych. A total of 201 abstracts were screened, of which 10 articles met the criteria. A 17-item standardised checklist was used to analyse the methodological quality of the studies. This checklist was derived from other systematic reviews which analysed the QoL of those with other health conditions and modified to suit the purpose of this review. The findings were synthesised to compare the overall QoL of older adults in comparison to younger age groups and to identify which QoL factors were the most and least negatively impacted by the presence of epilepsy and old age. Predictors of QoL were identified from findings that used a regression analysis and were rated regarding their strength of evidence. No clear differences for overall QoL were found between older and younger people with epilepsy. Participants reported energy/fatigue to be the most negatively impacted factor. Seizure frequency was a strong predictor of QoL, and comorbidity and depression were moderate predictors. The modest number of studies available for synthesis is a reflection of the gap in current literature on this topic. Future research needs to include more variables within their regression analysis to identify more predictors of QoL, and needs to compare QoL changes over the trajectory of older age.

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“…Patients were included in the analysis if they met the following criteria: (1) age C 4 years at index date; (2) C 1 prescription of ESL in the LTC pharmacy data at any time between 1 April 2014 and 31 December 2018 (i.e., the selection window); (3) deterministic linking of LTC pharmacy, prescription claims, and professional fee claims data from IQVIA's New Data Warehouse during the study period; (4) diagnosis of FS in professional fee claims or CDM (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] codes: 345.4X, 345.5X; ICD-10-CM codes: G40.0x, G40.1x, G40.2x) [24] during the 12 months prior to the index date (pre-index/baseline period), and including the index date; (5) activity in the 12-month pre-and post-index periods, defined as C 1 professional fee claim and C 1 prescription (LTC pharmacy database or prescription claims) as a proxy for continuous enrollment; (6) pharmacy stability in the LTC pharmacy database or prescription claims in the 12-month pre-and post-index periods, defined as consistent reporting of data from the pharmacy most frequently visited by the patient and C 80% coverage rate for each month in the 12-month pre-and post-index periods.…”

Section: Patient Populationmentioning

confidence: 99%

Healthcare Resource Utilization Among Patients with Focal Seizures Treated with Eslicarbazepine Acetate in the US Long-Term Care Setting: A Retrospective Claims Database Analysis

Mehta¹,

Shah²,

Desai³

et al. 2021

Neurol Ther

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Introduction:The aim of this study was to compare healthcare resource utilization (HCRU) before and after initiation of eslicarbazepine acetate (ESL) in the long-term care (LTC) setting (rehabilitation center, mental health center, LTC non-skilled nursing facility/assisted-living facility, home health, assisted living, nursing home, other/unknown). Methods: This retrospective analysis used IQVIA's New Data Warehouse, which includes deterministically linked LTC, prescription, and professional fee claims data and IQVIA Hospital Charge Data Master database. The study period was 1 April 2013 to 31 December 2019. The index date was the date of ESL initiation in the LTC setting. Inclusion criteria were: (1) C 1 new ESL prescription between 1 April 2014 and 31 December 2018; (2) diagnosis of focal seizure (FS) during the 12 months pre-index date; and (3) no ESL prescription during the 12-month period pre-index. A 12-month prepost analysis compared epilepsy-specific and all-cause HCRU before and after ESL initiation. Categorical variables were compared with McNemar's tests. Results: A total of 307 patients (mean age 52.2 years, 57.7% male) with FS were included, of whom 24.8% were in nursing homes. Patients used a mean of 3.1 antiseizure drugs prior to initiation of ESL, and 87.9% of patients initiated ESL as adjunctive treatment. There were significant reductions in proportion of patients with epilepsy specific physician office visits, emergency department (ED) visits, hospitareductions in the number of epillizations, and all-cause physician office visits and hospitalizations in the post-index period compared to the pre-index period (P \ 0.05). Similar results were observed in sensitivity (patients with an epilepsy diagnosis) and subgroup analyses [presence or absence of intellectual developmental disorders or age (C 65 and \ 65 years)]. Conclusion: Proportion of patients with epilepsy-specific physician office visits, ED visits, hospitalizations, and all-cause physician office visits and hospitalizations were significantly reduced following initiation of ESL in patients with FS in LTC.

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Prevalence of epilepsy/seizures as a comorbidity of neurologic disorders in nursing homes

Cited by 29 publications

References 38 publications

Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents

Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents

The quality of life of older adults with epilepsy: A systematic review

Healthcare Resource Utilization Among Patients with Focal Seizures Treated with Eslicarbazepine Acetate in the US Long-Term Care Setting: A Retrospective Claims Database Analysis

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