title: Assessment of antipsychotic prescribing in Belgian nursing homes.
abstract: BACKGROUND
  Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes.
  
  
  METHODS
  Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP).
  
  
  RESULTS
  The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61-4.09), insomnia (OR: 1.38; 95% CI: 1.10-1.73), depression (OR: 1.30; 95% CI: 1.03-1.65), and age <80 years (OR: 1.79; 95% CI: 1.38-2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17).
  
  
  CONCLUSIONS
  The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.
authors.affiliation: Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium. majda.azermai@ugent.be
authors.forename: Majda
authors.initials: M
authors.lastname: Azermai
authors.forename: Monique
authors.initials: M
authors.lastname: Elseviers
authors.forename: Mirko
authors.initials: M
authors.lastname: Petrovic
authors.forename: Luc
authors.initials: L
authors.lastname: van Bortel
authors.forename: Robert Vander
authors.initials: RV
authors.lastname: Stichele
mesh_terms: D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001530:Belgium; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy; D003863:Depression / Q000188:drug therapy; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011595:Psychomotor Agitation / Q000188:drug therapy; D011618:Psychotic Disorders / Q000188:drug therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy
chemical_list: D014150:Antipsychotic Agents