Antipsychotic drug use among elderly nursing home residents in the United States.
BACKGROUND
Antipsychotic utilization in elderly nursing home residents has increased substantially in recent years, primarily due to the use of atypical antipsychotic agents. However, few studies have examined antipsychotic utilization patterns in nursing home residents in the United States since the introduction of atypical agents in the 1990s.


OBJECTIVE
The goal of this study was to examine the prevalence of and the factors associated with antipsychotic drug use among elderly nursing home residents in the United States.


METHODS
This study involved a cross-sectional analysis of prescription and resident data files from the 2004 National Nursing Home Survey (NNNHS). The analysis focused on the use of 11 typical and 6 atypical antipsychotic agents among a nationally representative sample of elderly patients (aged > or =65 years). Descriptive weighted analysis was performed to examine antipsychotic prevalence patterns. Multiple logistic regression analysis within the conceptual framework of the Andersen behavioral model was used to examine the factors associated with antipsychotic drug use among the elderly nursing home residents.


RESULTS
According to the 2004 NNHS, 0.32 million elderly nursing home residents received antipsychotic medications, for an overall prevalence of 24.82%. Most received atypical agents (23.45%), while 1.90% received typical agents. Frequently reported diagnoses among the elderly using an antipsychotic agent were dementia (70%), depression (41%), and anxiety (18%). Among the predisposing characteristics, female gender and age (> or =85 years) were negatively associated with antipsychotic drug use. Need factors such as increasing dependence in decision-making ability regarding tasks of daily life, depressed mood indicators, behavioral symptoms, history of falls, and bowel incontinence were positively associated with antipsychotic drug use. In addition to the use of antipsychotic agents in schizophrenia and bipolar mania, this study found high use in conditions such as dementia, anxiety, depression, and parkinsonism in the elderly.


CONCLUSIONS
Nearly 1 in 4 elderly nursing home residents in the United States received antipsychotic agents. Predisposing and need factors played a vital role in determining the use of antipsychotic agents in these elderly patients. Overall, the study findings suggest that there is a need to monitor antipsychotic drug use by elderly patients in US nursing homes in light of recent efficacy and safety data on atypical agents.
Kamble
Pravin
P
Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, Texas 77030, USA.
Chen
Hua
H
Sherer
Jeff
J
Aparasu
Rajender R
RR
D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy; D003863:Depression / Q000188:drug therapy; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D055656:Prescriptions / Q000706:statistics & numerical data*; D015995:Prevalence; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D012111:Residence Characteristics; D014481:United States / Q000453:epidemiology
D014150:Antipsychotic Agents