Nursing homes in disadvantaged communities are more likely to overmedicate residents with antipsychotics, according to a study published Wednesday in JAMA Network Open.
“The neighborhood in which a nursing home is located seems to influence how widely antipsychotics are used, even when they may not be indicated,” Jasmine Travers, PhD, assistant professor at NYU Rory Meyers College of Nursing and the study’s senior author, said in a statement.
Antipsychotic medications can be helpful for serious psychiatric disorders such as schizophrenia. The drugs are often prescribed to residents with and without dementia who are agitated or have behavioral issues. The medications can be dangerous in older adults, raising their risks for falls, strokes and death.
“We know that nursing homes with lower staffing levels use more antipsychotics,” Travers said. “These medications may be compensating for understaffing by sedating residents instead of having adequate staff to support their needs.”
Residents in disadvantaged neighborhoods may be prone to even more stressors that can affect their mental health. Those stressors can affect sleep or cause agitation, which raises the risk that they may be put on an antipsychotic, even without the diagnosis the medications are indicated to treat.
The team examined data from 10,666 nursing homes in the United States. Of them, 1,867 were in severely disadvantaged neighborhoods.
Nursing homes that were understaffed (having less than three hours of care per resident each day) and in severely disadvantaged areas had 19.2% of residents on antipsychotics, while 17.1% of residents in less disadvantaged neighborhoods were given the drugs.
“This means that in a 100-bed nursing home that is understaffed, two additional residents would inappropriately receive an antipsychotic medication if the nursing home was in a disadvantaged neighborhood versus a more well-off area,” said Travers.
There wasn’t much of a difference in the amount of people on the drugs when nursing homes had at least three hours a day of care per patient.
“Addressing staffing deficiencies, particularly in nursing homes in disadvantaged neighborhoods, will be critical for reducing the overuse of antipsychotics,” said Travers. “Understanding this vulnerability can help inform policy solutions to support, not penalize, nursing homes in disinvested communities.”
