title: Off-Label Prescribing of Second-Generation Antipsychotics to Elderly Veterans with Posttraumatic Stress Disorder and Dementia.
abstract: OBJECTIVE
  To determine whether elderly veterans with posttraumatic stress disorder (PTSD) and dementia are more likely to be prescribed second-generation antipsychotics (SGAs) than those with PTSD alone.
  
  
  METHODS
  National serial cross-sectional study.
  
  
  METHODS
  Veterans Health Affairs inpatient and outpatient settings.
  
  
  METHODS
  Veterans aged 65 and older with PTSD (excluding schizophrenia or bipolar disorder) with or without concomitant dementia who received care from the Veterans Health Administration between 2003 and 2010 were identified using International Classification of Diseases, Ninth Revision, codes (N = 93,068; 11.1% with dementia).
  
  
  METHODS
  Trends in SGA prescribing and odds of being prescribed an SGA were determined using a multivariable logistic regression model adjusted for clinical, sociodemographic, and geographic covariates.
  
  
  RESULTS
  Between 2004 and 2009, SGA prescribing declined annually from 7.0% to 5.1% of elderly veterans with PTSD without dementia and 13.2% to 8.9% in those with dementia; findings over time consistently indicated that veterans with PTSD and dementia had at least twice the odds of being prescribed an SGA as those without PTSD (odds ratios 2.03 (95% confidence interval (CI) = 1.82-2.26) to 2.33 (95% CI = 2.10-2.58).
  
  
  CONCLUSIONS
  Although the prescribing of SGAs to elderly veterans with PTSD has decreased, prescribing an SGA to those with dementia remained consistently higher than for those with PTSD alone and is problematic given the high prevalence of medical comorbidities in this aging population coupled with the lack of compelling evidence for effectiveness of SGAs in individuals with dementia.
authors.affiliation: Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, Illinois.|Departments of Medicine, and Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Semla
authors.affiliation: Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts.|School of Insurance and Economics, University of International Business and Economics, Beijing, China.|Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Austin
authors.initials: A
authors.lastname: Lee
authors.affiliation: Mental Health Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ronald
authors.initials: R
authors.lastname: Gurrera
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.|Center for Organization, Leadership, and Management Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
authors.forename: Laura
authors.initials: L
authors.lastname: Bajor
authors.affiliation: Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts.
authors.forename: Mingfei
authors.initials: M
authors.lastname: Li
authors.affiliation: Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, Massachusetts.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.affiliation: Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, Massachusetts.|Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Eric G
authors.initials: EG
authors.lastname: Smith
authors.affiliation: School of Public Health, Boston University, Boston, Massachusetts.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.affiliation: School of Public Health, Boston University, Boston, Massachusetts.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wan
authors.affiliation: Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, Massachusetts.|Center for the Assessment of Pharmaceutical Practices, Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts.
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.|Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, Massachusetts.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D056687:Off-Label Use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D014150:Antipsychotic Agents
keywords: 
  PTSD
  ; antipsychotics; dementia; posttraumatic stress disorder