title: Reasons for psychiatric medication prescription for new nursing home residents.
abstract: OBJECTIVE
  This article focuses on justification of psychoactive medication prescription for NH residents during their first three months post-admission.
  
  
  METHODS
  We extracted data from 73 charts drawn from a convenience sample of individuals who were residents of seven nursing homes (NHs) for at least three months during 2009. Six focus groups with NH staff were conducted to explore rationales for psychoactive medication usage.
  
  
  RESULTS
  Eighty-nine percent of the residents who received psychoactive medications during the first three months of residence had a psychiatric diagnosis, and all residents who received psychoactive medications had a written physician's order. Mental status was monitored by staff, and psychoactive medications were titrated based on changes in mental status. One concern was that no Level II Preadmission Screening and Annual Resident Review (PASRR) evaluations were completed during the admissions process. Further, while 73% had mental health diagnoses at admission, 85% of the NH residents were on a psychoactive medication three months after admission, and 19% were on four or more psychoactive medications. Although over half of the residents had notes in their charts regarding non-psychopharmacological strategies to address problem behaviors, their number was eclipsed by the number receiving psychopharmacological treatment.
  
  
  CONCLUSIONS
  While the results suggest that NHs may be providing more mental health care than in the past, psychopharmacological treatment remains the dominant approach, perhaps because of limited mental health training of staff, and lack of diagnostic precision due to few trained geriatric mental health professionals. A critical review of the role of the PASRR process is suggested.
authors.affiliation: Department of Aging & Mental Health Disparities, University of South Florida, Tampa, USA. vmolinari@usf.edu
authors.forename: Victor A
authors.initials: VA
authors.lastname: Molinari
authors.forename: David A
authors.initials: DA
authors.lastname: Chiriboga
authors.forename: Laurence G
authors.initials: LG
authors.lastname: Branch
authors.forename: John
authors.initials: J
authors.lastname: Schinka
authors.forename: Lawrence
authors.initials: L
authors.lastname: Schonfeld
authors.forename: Lyn
authors.initials: L
authors.lastname: Kos
authors.forename: Whitney L
authors.initials: WL
authors.lastname: Mills
authors.forename: Jessica
authors.initials: J
authors.lastname: Krok
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005431:Florida; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D011619:Psychotropic Drugs