Antipsychotic Drug Use Among Elderly Nursing Home Residents in the United States

Background: Antipsychotic utilization in elderly nursing home residents has increased substantially in recent years, primarily due to the use of atypical antipsychotic agents. However, few studies have examined antipsychotic utilization patterns in nursing home residents in the United States since the introduction of a a typical agents in the 1990s. Objective: The goal of the study was to examine the prevalence of and the factors associated with antipsychotic drug use among elderly nursing home residents in the United States. Methods: This study involved a cross-sectional analysis of prescription and resident data files from the 2004 National Nursing Home Survey (NNHS). The analysis focused on the use of 11 typical and 6 atypical antipsychotic agents among a nationally representative sample of elderly patients (aged >= 65 years). Descriptive weighted analysis was performed to examine antipsychotic prevalence patterns. Multiple logistic regression analysis within the conceptual framework of the Andersen behavioral model was used to examine the factors associated with antipsychotic drug use among the elderly nursing home residents. Results: According to the 2004 NNHS, 0.32 million elderly nursing home residents received antipsychotic medications, for an overall prevalence of 24.82%. Most received atypical agents (23.45%), while 1.90% received typical agents. Frequently reported diagnosis among the elderly using an antipsychotic agent were dementia (70%), depression (41%), and anxiety (18%). Among the predisposing characteristics, female gender and age (>= 85 years) were ability regarding tasks of daily life, depressed mood indicators, behavioral symptoms, history of falls, and bowel incontinence were positively associated with antipsychotic drug use. In addition to the use of antipsychotic agents in schizophrenia and bipolar mania, this study found high use in conditions such as dementia, anxiety, depression, and parkinsonism in the elderly. Conclusions: Nearly 1 in 4 elderly nursing residents in the United States received antipsychotic agents. Predisposing and need factors played a vital role in determining the use of antipsychotic drug use by elderly patients in US nursing homes in light of recent efficacy and safety data on atypical agents. (Am J Geriatr Pharmacother 2008;6:187-197) (C) 2008 Excerpta Medica Inc.