The Quality of Antipsychotic Drug Prescribing in Nursing Homes

Briesacher, Becky A.; Limcangco, M. Rhona; Simoni, Jane M.; Doshi, Jalpa A.; Levens, Suzi; Shea, Dennis G.; Stuart, Bruce

doi:10.1001/archinte.165.11.1280

Cited by 191 publications

(160 citation statements)

References 25 publications

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“…Contrary to expectations, two out of three patients on antipsychotics in the present study were prescribed conventional drugs. Jn most of the previous studies outside Europe, the ratio of atypical to conventional antipsychotic use is 3:2 or 2: 1 (8,9,35,36), although these reports came from studies on elderly residents in long-term institutional care. Variations between countries in the ratio of atypical to typical antipsychotic use may be due to the different costs and national reimbursement policies as well as to prescription rules and procedures.…”

Section: Aging Elinmentioning

confidence: 99%

Use of antipsychotic medications in older home-care patients. Report from nine European countries

et al. 2008

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Section: Aging Elinmentioning

confidence: 99%

Use of antipsychotic medications in older home-care patients. Report from nine European countries

et al. 2008

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“…1 In nursing homes, psychotropic agents are given to up to twothirds of dementia patients. [2][3][4][5] The safety of antipsychotic medications in older adults has been called into question. The United States Food and Drug Administration and Health Canada have issued advisories stating that certain atypical antipsychotics (risperidone, olanzapine and aripiprazole) have been associated with an increased risk of stroke and transient ischemic events, and both atypical and conventional antipsychotics have been associated with an increased risk of death.…”

mentioning

confidence: 99%

Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes

Huybrechts¹,

Rothman²,

Silliman³

et al. 2011

Canadian Medical Association Journal

109

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Research CMAJBackground: Despite safety-related concerns, psychotropic medications are frequently prescribed to manage behavioural symptoms in older adults, particularly those with dementia. We assessed the comparative safety of different classes of psychotropic medications used in nursing home residents. Methods:We identified a cohort of patients who were aged 65 years or older and had initiated treatment with psychotropics after admission to a nursing home in British Columbia between 1996 and 2006. We used proportional hazards models to compare rates of death and rates of hospital admissions for medical events within 180 days after treatment initiation. We used propensity-score adjustments to control for confounders. CI 0.86-1.94 for antidepressants). Users of benzodiazepines had a higher risk of death (RR 1.28, 95% CI 1.04-1.58) compared with users of atypical antipsychotics. The RR for heart failure was 1.54 (95% CI 0.89-2.67), and for pneumonia it was 0.85 (95% CI 0.56-1.31). ResultsInterpretation: Among older patients admitted to nursing homes, the risks of death and femur fracture associated with conventional antipsychotics, antidepressants and benzodiazepines are comparable to or greater than the risks associated with atypical antipsychotics. Clinicians should weigh these risks against the potential benefits when making prescribing decisions. Abstract

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“…A recent report indicates that there is still considerable use of FGAs among older people. Based on data for 2.5 million Medicare beneficiaries in nursing homes during 2001, Briesacher et al (2005 reported that an estimated 27.6% of all Medicare beneficiaries were prescribed an antipsychotic drug at least once; about one quarter of them (7.3% of all Medicare beneficiaries) received an FGA.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Tardive Dyskinesia with Risperidone or Olanzapine in the Elderly: Results from a 2-Year, Prospective Study in Antipsychotic-Naïve Patients

Woerner

Correll

Alvir

et al. 2011

Neuropsychopharmacol

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Tardive dyskinesia (TD) rates with second-generation antipsychotics (SGAs) are considered to be low relative to first-generation antipsychotics (FGAs), even in the particularly vulnerable elderly population. However, risk estimates are unavailable for patients naïve to FGAs. Therefore, we aimed to determine the TD incidence in particularly vulnerable, antipsychotic-naïve elderly patients treated with the SGA risperidone or olanzapine. The present work describes a prospective inception cohort study of antipsychotic-naïve elderly patients aged X55 years identified at New York Metropolitan area in-patient and out-patient geriatric psychiatry facilities and nursing homes at the time of risperidone or olanzapine initiation. At baseline, 4 weeks, and at quarterly periods, patients underwent assessments of medical and medication history, abnormal involuntary movements, and extra-pyramidal signs. TD was classified using Schooler-Kane criteria. Included in the analyses were 207 subjects (age: 79.8 years, 70.0% female, 86.5% White), predominantly diagnosed with dementia (58.9%) or a major mood disorder (30.9%), although the principal treatment target was psychosis (78.7%), with (59.4%) or without (19.3%) agitation. With risperidone (n ¼ 159) the cumulative TD rate was 5.3% (95% confidence interval (CI): 0.7, 9.9%) after 1 year (mean dose: 1.0±0.76 mg/day) and 7.2% (CI: 1.4, 12.9%) after 2 years. With olanzapine (n ¼ 48) the cumulative TD rate was 6.7% (CI: 0, 15.6%) after 1 year (mean dose: 4.3±1.9 mg/day) and 11.1% (CI: 0, 23.1%) after 2 years. TD risk was higher in females, African Americans, and patients without past antidepressant treatment or with FGA co-treatment. The TD rates for geriatric patients treated with risperidone and olanzapine were comparable and substantially lower than previously reported for similar patients in direct observation studies using FGAs. This information is relevant for all patients receiving antipsychotics, not just the especially sensitive elderly.

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The Quality of Antipsychotic Drug Prescribing in Nursing Homes

Cited by 191 publications

References 25 publications

Use of antipsychotic medications in older home-care patients. Report from nine European countries

Use of antipsychotic medications in older home-care patients. Report from nine European countries

Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes

Incidence of Tardive Dyskinesia with Risperidone or Olanzapine in the Elderly: Results from a 2-Year, Prospective Study in Antipsychotic-Naïve Patients

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