The impact of legislation on psychotropic drug use in nursing homes: a cross-national perspective.
OBJECTIVE
To quantify the impact of legislation on nursing home residents, psychotropic drug use, and the occurrence of falls in the US compared with five countries with no such regulation.


METHODS
A retrospective cross-sectional study


METHODS
Nursing homes in five US states and selected nursing homes in Denmark, Iceland, Italy, Japan, and Sweden.


METHODS
Residents in nursing homes in five US states and the aforementioned countries during 1993-1996.


METHODS
Using data collected using the Minimum Data Set, logistic regression provided estimates of the legislative effects on the use of antipsychotics and antianxiety/hypnotics while simultaneously adjusting for potential confounders. The occurrence of falls was evaluated similarly.


RESULTS
Prevalence of antipsychotic and/or antianxiety/ hypnotic use varied substantially across countries. After adjustment for differences in age, gender, presence of psychiatric/neurologic conditions, and physical and cognitive functioning, residents in Denmark, Italy, and Sweden were at least twice as likely to receive these drugs (Denmark Odds Ratio (OR)=2.32; 95% Confidence Intervals (CI), 2.15-2.51; Italy OR=2.05; 95% CI, 1.78-2.34; Sweden OR=2.50; 95% CI, 2.16-2.90); in Iceland, the risk was increased to greater than 6 times (OR=6.54; 95% CI, 5.75-7.44) that of the US. Residents were less likely to fall in Italy, Iceland, and Japan compared with the US, despite more extensive use of psychotropic medication, whereas residents in Sweden and Denmark were more likely to fall.


CONCLUSIONS
Policy has had an impact on the prescribing of psychotropic medication in US nursing homes compared with other countries, but it is unclear if this is translated into better outcomes for residents.
Hughes
C M
CM
School of Pharmacy, The Queen's University of Belfast, N. Ireland.
Lapane
K L
KL
Mor
V
V
Ikegami
N
N
Jónsson
P V
PV
Ljunggren
G
G
Sgadari
A
A
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003718:Denmark; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005161:Facility Regulation and Control / Q000331:legislation & jurisprudence*; D005260:Female; D015577:Geriatric Assessment; D006701:Home Nursing / Q000331:legislation & jurisprudence*; D006801:Humans; D007055:Iceland; D007558:Italy; D007564:Japan; D016015:Logistic Models; D008297:Male; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000627:therapeutic use*; D012149:Restraint, Physical / Q000009:adverse effects / Q000331:legislation & jurisprudence; D012189:Retrospective Studies; D013548:Sweden; D014481:United States
D011619:Psychotropic Drugs