A retrospective, longitudinal study of factors associated with new antipsychotic medication use among recently admitted long-term care residents.
BACKGROUND
Use of antipsychotic (AP) medications is high and often inappropriate among institutionalized populations. Little is known about the correlates of new AP drug use following admission to long-term care (LTC) settings. This study investigated the frequency and correlates of new AP drug use among newly admitted LTC residents.


METHODS
This longitudinal, retrospective study used data from the interRAI - Nursing Home Minimum Data Set version 2.0 (MDS 2.0) instrument. Data about demographic, clinical and social characteristics, and medication use, were collected in Ontario, Canada, from 2003-2011 by trained nurses. Residents with complete admission and 3-6 month follow-up data were included (N = 47,768). Multivariate logistic regression analyses, stratified by gender, explored correlates of new AP drug use upon admission to LTC.


RESULTS
New AP drug users comprised 7 % of the final cohort. Severe cognitive impairment, dementia, and motor agitation were significantly associated with new AP drug use among both sexes. Additionally, behavioural problems, conflicts with staff and reduced social engagement were strong correlates of new AP drug use.


CONCLUSIONS
Social factors were as strongly associated with new AP drug use after LTC admission as clinical factors. Strategies to prevent the potential misuse of AP drugs upon LTC admission should consider the social determinants of such prescribing.
Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden. andrea.foebel@ki.se.|School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. andrea.foebel@ki.se.
Andrea
A
Foebel
Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic. anna.ballokova@seznam.cz.
Anna
A
Ballokova
Department of Public Health and Primary Care, Center for Health Services and Nursing Research, KULeuven, Leuven, Belgium. Nathalie.Wellens@med.kuleuven.be.|Geriatrics Center and Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA. Nathalie.Wellens@med.kuleuven.be.
Nathalie I H
NI
Wellens
Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic. Daniela.Fialova@lf1.cuni.cz.|Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Prague, Czech Republic. Daniela.Fialova@lf1.cuni.cz.
Daniela
D
Fialova
Department of Public Health and Primary Care, Center for Health Services and Nursing Research, KULeuven, Leuven, Belgium. Koen.Milisen@med.kuleuven.be.|Division of Geriatric Medicine, Leuven University Hospital, Herestraat 49, Leuven, 3000, Belgium. Koen.Milisen@med.kuleuven.be.
Koen
K
Milisen
Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy. rosella.liperoti@rm.unicatt.it.
Rosa
R
Liperoti
School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. hirdes@uwaterloo.ca.
John P
JP
Hirdes
D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care / Q000523:psychology* / Q000639:trends*; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes / Q000639:trends*; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000639:trends*; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D012189:Retrospective Studies
D014150:Antipsychotic Agents