Factors associated with psychotropic drug usage among nursing home residents with dementia.
BACKGROUND
Although federal regulations hold nursing homes responsible for monitoring psychotropic drug (PD) usage, there is a high prevalence of PD usage and significant variation in use across nursing homes.


OBJECTIVE
The aims of study were to (a) describe current PD usage in nursing homes and (b) examine resident and nursing home factors associated with PD usage in nursing home residents with dementia.


METHODS
A multivariate, multisite, cross-sectional descriptive study was used on data from 107 dementia patients residing in nine randomly selected nursing homes in southeastern Michigan. The PD usage of interest included antipsychotics, antidepressants, anxiolytics or sedatives, and mood stabilizers. Regression analysis tested resident factors, including cognitive ability, functional ability, presence of depressive symptoms, and demographic characteristics, and three facility factors (nursing home size, type of ownership, and level of registered nurse [RN] staffing) in comparison with PD usage.


RESULTS
In this study, 67.3% of the participants received at least one PD. The most frequently prescribed PDs were antidepressants (41.1%) and antipsychotics (37.4%). Newly developed antipsychotics such as risperidone were given more frequently to residents than were conventional drugs such as haloperidol. Regression analysis suggests that the presence of depressive symptoms (odds ratio [OR]= 3.5, p < .01) and low levels of RN staffing (OR = 1.0, p < .01) were associated with the use of PD.


CONCLUSIONS
Psychotropic drugs are prescribed frequently for nursing home residents, although such usage is variable. Behavioral symptoms were not an independent predictive factor for PD use. Rather, combined resident and facility characteristics best predicted the use of PDs in nursing home residents. The evaluation of nursing home systems for these characteristics as predictive factors for PD usage in nursing home patients with dementia is suggested by the results. Likewise, attention to new drugs such as selective serotonin reuptake inhibitors and their appropriate use is recommended.
Kim
Hyojeong
H
University of Michigan School of Nursing, Ann Arbor, MI 48109-0482, USA. hyjeonz@umich.edu
Whall
Ann L
AL
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy*; D004363:Drug Utilization; D005260:Female; D006276:Health Facility Size; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008824:Michigan; D015999:Multivariate Analysis; D009735:Nursing Homes; D010561:Personnel Staffing and Scheduling; D011619:Psychotropic Drugs
D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs