Vol. 12 No. 2 - February, 2010

Nursing home culture may affect antipsychotic prescription rates

In 2007, almost one-third of U.S. nursing home residents received antipsychotic drugs, according to the article.

A recent study led by UMass Medical School researchers shows that older adults, some of whom who have no identified clinical need, are being prescribed antipsychotic drugs at high rates, according to a report in the Jan. 11 issue of Archives of Internal Medicine, one of the Journal of American Medicine (JAMA)/Archives journals.

In 2007, almost one-third of U.S. nursing home residents received antipsychotic drugs, according to the article. Safety concerns regarding their use are increasing. In 2005, the Food and Drug Administration issued warnings about the risk of death among older adults with dementia taking these agents to control behavioral symptoms. In fact, a large clinical trial recently concluded that the adverse effects outweighed the benefits in patients with Alzheimer’s disease.

 The research team, which included Jerry H. Gurwitz, MD, the Dr. John Meyers Professor of Primary Care Medicine and professor of medicine and family medicine & community health; Becky A. Briesacher, PhD, associate professor of medicine; and Yong Chen, MD, a PhD student in the Meyers Primary Care Institute mentored by Dr. Briesacher, with colleagues from Northwestern University, assessed antipsychotic prescribing among 16,586 residents newly admitted to 1,257 nursing homes in 2006. They computed each facility’s antipsychotic prescription rates based on 2005 prescribing patterns and analyzed whether these rates, along with individual characteristics, were associated with the likelihood of new residents receiving antipsychotic prescriptions.

About 30 percent of new residents in the study received at least one antipsychotic medication in 2006, of whom 32 percent did not have dementia, psychosis or any other clinical indication for this therapy. “ the authors noted. “The influence of the facility-level prescribing rate was most apparent in residents without psychosis, who have the weakest indication for antipsychotic medication use.”

The study suggests that organizational culture at some nursing homes may encourage the prescribing of antipsychotics. “Future research is needed to determine why such a prescribing culture exists and whether there are adverse health consequences as a result of our observed facility-level antipsychotic prescribing rate,” the authors conclude. “This study may also inform future policies to target nursing homes with high antipsychotic prescribing rates to improve quality of care for nursing home residents.”