title: Use of antipsychotics among older residents in VA nursing homes.
abstract: BACKGROUND
  Antipsychotic medications are commonly prescribed to nursing home residents despite their well-established adverse event profiles. Because little is known about their use in Veterans Affairs (VA) nursing homes [ie, Community Living Centers (CLCs)], we assessed the prevalence and risk factors for antipsychotic use in older residents of VA CLCs.
  
  
  METHODS
  This cross-sectional study included 3692 Veterans age 65 or older who were admitted between January 2004 and June 2005 to one of 133 VA CLCs and had a stay of ≥90 days. We used VA Pharmacy Benefits Management data to examine antipsychotic use and VA Medical SAS datasets and the Minimum Data Set to identify evidence-based indications for antipsychotic use (eg, schizophrenia, dementia with psychosis). We used multivariable logistic regression and generalized estimating equations to identify factors independently associated with antipsychotic receipt.
  
  
  RESULTS
  Overall, 948/3692(25.7%) residents received an antipsychotic, of which 59.3% had an evidence-based indication for use. Residents with aggressive behavior [odds ratio (OR)=2.74, 95% confidence interval (CI), 2.04-3.67] and polypharmacy (9+ drugs; OR=1.84, 95% CI, 1.41-2.40) were more likely to receive antipsychotics, as were users of antidepressants (OR=1.37, 95% CI, 1.14-1.66), anxiolytic/hypnotics (OR=2.30, 95% CI, 1.64-3.23), or drugs for dementia (OR=1.52, 95% CI, 1.21-1.92). Those residing in Alzheimer/dementia special care units were also more likely to receive an antipsychotic (OR=1.66, 95% CI, 1.26-2.21). Veterans with dementia but no documented psychosis were as likely as those with an evidence-based indication to receive an antipsychotic (OR=1.10, 95% CI, 0.82-1.47).
  
  
  CONCLUSIONS
  Antipsychotic use is common among VA nursing home residents aged 65 and older, including those without a documented evidence-based indication for use. Further quality improvement efforts are needed to reduce potentially inappropriate antipsychotic prescribing.
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive, Pittsburgh, PA 15206, USA. walid.gellad@va.gov
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
authors.forename: Sherrie L
authors.initials: SL
authors.lastname: Aspinall
authors.forename: Steven M
authors.initials: SM
authors.lastname: Handler
authors.forename: Roslyn A
authors.initials: RA
authors.lastname: Stone
authors.forename: Nicholas
authors.initials: N
authors.lastname: Castle
authors.forename: Todd P
authors.initials: TP
authors.lastname: Semla
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Maurice
authors.initials: M
authors.lastname: Dysken
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000008:administration & dosage; D000928:Antidepressive Agents / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D019338:Polypharmacy; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents