Antipsychotic and benzodiazepine use among nursing home residents: findings from the 2004 National Nursing Home Survey.
OBJECTIVE
To document the extent and appropriateness of use of antipsychotics and benzodiazepines among nursing home residents using a nationally representative survey.


METHODS
Cross-sectional analysis of the 2004 National Nursing Home Survey. Bivariate and multivariate analyses examined relationships between resident and facility characteristics and antipsychotic and benzodiazepine use by appropriateness classification among residents aged 60 years and older (N = 12,090). Resident diagnoses and information about behavioral problems were used to categorize antipsychotic and benzodiazepine use as appropriate, potentially appropriate, or having no appropriate indication.


RESULTS
More than one quarter (26%) of nursing home residents used an antipsychotic medication, 40% of whom had no appropriate indication for such use. Among the 13% of residents who took benzodiazepines, 42% had no appropriate indication. In adjusted analyses, the odds of residents taking an antipsychotic without an appropriate indication were highest for residents with diagnoses of depression (odds ratio [OR] = 1.31; 95% confidence interval [CI]: 1.12-1.53), dementia (OR = 1.82; 95% CI: 1.52-2.18), and with behavioral symptoms (OR = 1.97, 95% CI: 1.56-2.50). The odds of potentially inappropriate antipsychotic use increased as the percentage of Medicaid residents in a facility increased (OR = 1.08, 95% CI: 1.02-1.15) and decreased as the percentage of Medicare residents increased (OR = 0.46, 95% CI: 0.25-0.83). The odds of taking a benzodiazepine without an appropriate indication were highest among residents who were female (OR = 1.44; 95% CI: 1.18-1.75), white (OR = 1.95; 95% CI: 1.47-2.60), and had behavioral symptoms (OR = 1.69; 95% CI: 1.41-2.01).


CONCLUSIONS
Antipsychotics and benzodiazepines seem to be commonly prescribed to residents lacking an appropriate indication for their use.
Stevenson
David G
DG
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. stevenson@hcp.med.harvard.edu
Decker
Sandra L
SL
Dwyer
Lisa L
LL
Huskamp
Haiden A
HA
Grabowski
David C
DC
Metzger
Eran D
ED
Mitchell
Susan L
SL
D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys / Q000379:methods*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D014481:United States
D014150:Antipsychotic Agents; D001569:Benzodiazepines
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