The Use of Atypical Antipsychotics in Nursing Homes
J Clin Psychiatry 2003;64(9):1106-1112
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Use of atypical
antipsychotics for "off-label" indications, such as
behavioral and psychological symptoms of dementia, depression,
and bipolar disorder, have been frequently reported, although not
systematically studied. We describe the pattern of atypical
antipsychotic use among nursing home residents and identify
demographic and clinical correlates.
Method: We conducted a cross-sectional study on
139,714 nursing home residents living in 1732 nursing homes in 5
U.S. states from Jan. 1, 1999, to Jan. 31, 2000. Data were
obtained from the computerized Minimum Data Set (MDS) assessment
Results: Behavior problems associated
with cognitive impairment were manifest in 86,514 residents, and,
of these, 18.2% received an antipsychotic. Approximately 11%
received an atypical antipsychotic, while 6.8% received a
conventional agent. Clinical correlates of atypical antipsychotic
use were Parkinson's disease (adjusted odds ratio [OR] = 1.57,
95% confidence interval [CI] = 1.34 to 1.84), depression (OR =
1.35, 95% CI = 1.24 to 1.46), antidepressant use (OR = 1.38, 95%
CI = 1.27 to 1.49), Alzheimer's disease (OR = 1.21, 95% CI = 1.12
to 1.32), non-Alzheimer dementia (OR = 1.15, 95% CI = 1.07 to
1.24), and cholinesterase inhibitor use (OR = 1.74, 95% CI = 1.52
to 1.98). Severe functional impairment was inversely related to
atypical antipsychotic use (OR = 0.76, 95% CI = 0.65 to 0.89).
Conclusion: Atypical antipsychotics are
now used more than conventional antipsychotic agents in U.S.
nursing homes. Indications and dosages seem appropriate relative
to labeling. Clinical and demographic differences between
atypical and conventional antipsychotic users tend to be
relatively small, suggesting that other factors may explain the
choice of prescribing physicians. The impact of facility factors,
economic forces, and physician characteristics needs to be