Antidepressant prescribing in US nursing homes between 1996 and 2006 and its relationship to staffing patterns and use of other psychotropic medications.
BACKGROUND
Few studies have examined factors associated with antidepressant prescribing in older nursing home residents.


OBJECTIVE
The primary objective was to describe the change in antidepressant prescribing for nursing home residents between 1996 and 2006. An additional objective was to examine the association between any change in antidepressant prescribing and staffing patterns or coprescribing of other psychotropic medications in the same cohort.


METHODS
Longitudinal.


METHODS
Settings were 12,556 US nursing homes in 1996 and 2006.


METHODS
Online Survey Certification and Reporting (OSCAR) data and the Area Resource File (ARF).


METHODS
Increasing prescribing of antidepressants analyzed using multivariable multinomial generalized estimating equations (GEE).


RESULTS
Antidepressant prescribing significantly increased (P < .05) from 21.9% in 1996 to 47.5% in 2006. After controlling for resident, organizational, and market factors, increased antidepressant prescribing was associated with more time spent by physician extenders (adjusted odds ratio [AOR] 2.21; 95% confidence interval [CI] 1.96-2.51), registered nurses (AOR 1.06, 95% CI 1.02-1.10), or nurse aides (AOR 1.08; 95%CI 1.04-1.12) in a facility, as well as the coprescribing of sedative/hypnotics (AOR 1.12; 95% CI 1.08-1.16). Factors found to be protective of increasing antidepressant prescribing (ie, decrease antidepressant prescribing) included having medical directors and physicians spend more time in the facility (AOR 0.60; 95% CI 0.53-0.69 and AOR 0.62; 95% CI 0.54-0.71, respectively), or coprescribing of antianxiety or antipsychotic agents (AOR 0.70; 95% CI 0.68-0.72 and AOR 0.74; 95% CI 0.72-0.77, respectively).


CONCLUSIONS
Prescribing of antidepressants has increased dramatically in the past decade in older nursing home residents and seems to be associated with certain staffing characteristics and the coprescribing of psychotropic medications. Further research is needed to determine if antidepressants are appropriately prescribed, and if overuse is determined, develop interventions to improve the quality of prescribing of these medications in older nursing home residents.
Hanlon
Joseph T
JT
Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. jth14@pitt.edu
Handler
Steven M
SM
Castle
Nicholas G
NG
D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D009735:Nursing Homes / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D010818:Practice Patterns, Physicians'; D014481:United States
D000928:Antidepressive Agents