title: Antipsychotic and benzodiazepine use among nursing home residents: findings from the 2004 National Nursing Home Survey.
abstract: 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.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. stevenson@hcp.med.harvard.edu
authors.forename: David G
authors.initials: DG
authors.lastname: Stevenson
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Decker
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Dwyer
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.forename: Eran D
authors.initials: ED
authors.lastname: Metzger
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
mesh_terms: 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
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines
references.citation: Psychiatr Serv. 2002 Sep;53(9):1159-65
references.pmid: 12221316
references.citation: Am J Med. 2000 Aug 1;109(2):87-94
references.pmid: 10967148
references.citation: Drugs Aging. 2008;25(5):381-98
references.pmid: 18447403
references.citation: Am J Med. 2005 Mar;118(3):251-8
references.pmid: 15745723
references.citation: Med Care. 2000 Dec;38(12):1164-73
references.pmid: 11186295
references.citation: Med Care. 2006 Mar;44(3):243-9
references.pmid: 16501395
references.citation: Am Fam Physician. 2000 Mar 1;61(5):1437-46
references.pmid: 10735348
references.citation: Biometrics. 2000 Jun;56(2):645-6
references.pmid: 10877330
references.citation: Curr Pharm Des. 2002;8(1):45-58
references.pmid: 11812249
references.citation: J Clin Psychiatry. 2003 Sep;64(9):1106-12
references.pmid: 14628988
references.citation: Arch Intern Med. 2005 Jun 13;165(11):1280-5
references.pmid: 15956008
references.citation: Arch Intern Med. 2008 May 26;168(10):1090-6
references.pmid: 18504337
references.citation: Am J Geriatr Psychiatry. 2009 Jul;17(7):614-20
references.pmid: 19546656
references.citation: Am Fam Physician. 2000 Apr 1;61(7):2121-8
references.pmid: 10779253
references.citation: N Engl J Med. 2006 Oct 12;355(15):1525-38
references.pmid: 17035647
references.citation: JAMA. 2008 Jul 23;300(4):379-80
references.pmid: 18647971
references.citation: J Clin Psychiatry. 2004;65 Suppl 2:5-99; discussion 100-102; quiz 103-4
references.pmid: 14994733
references.citation: Am J Geriatr Psychiatry. 2008 Aug;16(8):621-32
references.pmid: 18669940
references.citation: Am J Psychiatry. 2008 Jul;165(7):844-54
references.pmid: 18519523
references.citation: Ann Intern Med. 1995 Aug 1;123(3):195-204
references.pmid: 7598302
references.citation: Gerontologist. 2003 Apr;43 Spec No 2:37-46
references.pmid: 12711723
references.citation: J Am Geriatr Soc. 2000 Jun;48(6):682-5
references.pmid: 10855607
references.citation: Arch Intern Med. 2003 Dec 8-22;163(22):2716-24
references.pmid: 14662625
references.citation: NHPF Issue Brief. 2002 Nov 12;(784):1-18
references.pmid: 12463231
references.citation: Am J Geriatr Psychiatry. 2008 Aug;16(8):686-92
references.pmid: 18669947
references.citation: J Am Geriatr Soc. 2001 Dec;49(12):1673-8
references.pmid: 11844002
references.citation: J Affect Disord. 2004 Mar;78(3):201-8
references.pmid: 15013244
references.citation: Ann Intern Med. 2007 Jun 5;146(11):775-86
references.pmid: 17548409
references.citation: Am J Psychiatry. 2001 Jun;158(6):892-8
references.pmid: 11384896
references.citation: Am J Geriatr Psychiatry. 2009 May;17(5):417-27
references.pmid: 19390299