title: Urban-rural patterns of increasing antidepressant use among nursing facility residents.
abstract: OBJECTIVE
  To characterize changing patterns of antidepressant use in nursing facilities across the urban-rural continuum during the mid-1990s.
  
  
  METHODS
  Retrospective analysis of antidepressant drug codes and demographic/clinical data from the Minimum Data Set (MDS) 1994 to 1997.
  
  
  METHODS
  Kansas nursing facilities.
  
  
  METHODS
  Facility residents aged 65 and older.
  
  
  METHODS
  We examined (1) admission use and (2) after-admission use for newer and older antidepressants for each year separately, using a 4-stratum system to classify nursing facility location by county, from urban to most rural. Incidence rate ratios were determined for antidepressant use in each stratum using the urban strata as the reference.
  
  
  RESULTS
  Remarkable increases in use of newer antidepressants were seen over time in all strata, but use was highest in the urban area. Modest urban-rural gradient effects attenuated over time and were not consistently seen across analyses and years. Tricyclic antidepressant (TCA) use remained largely unchanged over time and at much lower rates than newer agents. However, TCA use was also modestly higher in urban areas. Differences were clearer for use after admission, in contrast with admission use patterns.
  
  
  CONCLUSIONS
  Newer antidepressants were rapidly adopted across the urban-rural continuum from 1994 to 1997. Marked increases in both admission and after-admission use of newer antidepressants were seen. Both newer and older antidepressants were used at modestly higher rates in urban areas. Further work is needed to elucidate the patient, prescriber, and facility factors that explain these prescribing patterns.
authors.affiliation: Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS 66160-7117, USA.
authors.forename: Sally K
authors.initials: SK
authors.lastname: Rigler
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.forename: Linda
authors.initials: L
authors.lastname: Redford
authors.forename: Stephanie
authors.initials: S
authors.lastname: Studenski
authors.forename: Edward F
authors.initials: EF
authors.lastname: Brown
authors.forename: Dennis
authors.initials: D
authors.lastname: Wallace
authors.forename: Melissa
authors.initials: M
authors.lastname: Webb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic