The use of antidementia and antipsychotic drugs for treating nursing home residents with dementia varies considerably across the United States, suggesting the need for better guidelines for healthcare providers to follow in prescribing those medications to residents, according to a new study.
Researchers from the University of Massachusetts Chan Medical School studied regional variations in the use of antipsychotic and antidementia medications, such as memantine and cholinesterase inhibitors, at 9,735 nursing homes in 289 hospital referral regions. They used Medicare data, facility information and Dartmouth Atlas files to calculate the use of those drugs at nursing homes in different regions.
The study, which appeared in the journal Medical Care, found that overall, 20.9% of the facilities used antipsychotics, 16.1% used memantine and 23.3% used cholinesterase inhibitors. Nursing homes in hospital referral regions with the highest healthcare utilization rates had greater antidementia drug use.
“Regional variations exist in antipsychotic and antidementia medication use among nursing home residents with dementia, suggesting the need for evidence-based protocols to guide the use of these medications,” the authors concluded.
Matthew Alcusky, PhD, PharmD, an associate professor of population and quantitative health sciences at UMass Chan Medical School who led the National Institutes of Health-funded study, noted in a news release that the drugs used to treat Alzheimer’s in this study were only modestly clinically effective and often carry side effects.
The authors also pointed out that antipsychotics carry an Food and Drug Administration black box warning because of increased risks for mortality and cerebrovascular events in older adults and yet still were being used by one in five residents in the study.
“There’s really a gap of understanding how they’re being used in nursing homes and to what effect,” Alcuksy said in the statement. “We suspected that there was going to be a lot of variation that was borne out in this study because of conflicting recommendations or lacking recommendations from consensus guidelines.”
Factors specific to facilities and residents also influenced the use of the drugs. The researchers found that facilities that used physical restraints or that had poor staffing ratings also had higher antipsychotic use.
“The facilities that were ranked poor on staffing quality and the facilities that had evidence of using physical restraints were associated with higher prevalence of antipsychotics,” said Kate Lapane, PhD, the study’s senior author and professor of population and quantitative health sciences at the UMass Chan Medical School, in the news release.
“Whereas with antidementia drugs, the higher prevalence [of use] was associated with higher healthcare utilization in the area, and perhaps a reflection of what residents were receiving in the community that carried into the nursing home,” Lapane said, noting that different phenomenon were driving each class of drug use.
Alcusky said in the news release that about 50% of nursing home residents have Alzheimer’s disease or another form of dementia, highlighting the need for further research on therapeutic treatments.
He said he hopes that the study’s findings will lead to the development of clearer guidelines for the use of the drugs by nursing homes to improve decision making for caregivers, residents and their families.
