State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia
Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved..
OBJECTIVES: More than two-thirds of assisted living (AL) residents have dementia or cognitive impairment and antipsychotics are commonly prescribed for behavioral disturbances. As AL communities are regulated by state-level policies, which vary significantly regarding the care for people with dementia, we examined how antipsychotic prescribing varied across states among AL residents with dementia.
DESIGN: This was an observational study using 20% sample of national Medicare data in 2017.
SETTING AND PARTICIPANTS: The study cohort included Medicare beneficiaries with dementia aged 65 years or older who resided in larger (≥25-bed) ALs in 2017.
METHODS: The study outcome was the percentage of eligible AL person-months in which antipsychotics were prescribed for each state. We used a random intercept linear regression model to shrink estimates toward the overall mean use of antipsychotics addressing unstable estimates due to small sample sizes in some states.
RESULTS: A total of 20,867 AL residents with dementia were included in the analysis, contributing to 194,718 person-months of observation. On average, AL residents with dementia were prescribed antipsychotics during 12.6% of their person-months. This rate varied significantly by state, with a low of 7.8% (95% CI 5.9%-10.3%) for Hawaii to a high of 20.5% (95% CI 16.4%-25.3%) for Wyoming.
CONCLUSIONS AND IMPLICATIONS: We observed significant state variation in the prescribing of antipsychotics among AL residents with dementia using national data. These variations may reflect differences in state regulations regarding the care for AL residents with dementia and suggest the need for further investigation to ensure high quality of care.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Journal of the American Medical Directors Association - 24(2023), 4 vom: 01. Apr., Seite 555-558.e1 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhang, Tingting [VerfasserIn] |
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| Links: |
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| Themen: |
Antipsychotic Agents |
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| Anmerkungen: |
Date Completed 04.04.2023 Date Revised 02.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jamda.2023.01.014 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: More than two-thirds of assisted living (AL) residents have dementia or cognitive impairment and antipsychotics are commonly prescribed for behavioral disturbances. As AL communities are regulated by state-level policies, which vary significantly regarding the care for people with dementia, we examined how antipsychotic prescribing varied across states among AL residents with dementia | ||
| 520 | |a DESIGN: This was an observational study using 20% sample of national Medicare data in 2017 | ||
| 520 | |a SETTING AND PARTICIPANTS: The study cohort included Medicare beneficiaries with dementia aged 65 years or older who resided in larger (≥25-bed) ALs in 2017 | ||
| 520 | |a METHODS: The study outcome was the percentage of eligible AL person-months in which antipsychotics were prescribed for each state. We used a random intercept linear regression model to shrink estimates toward the overall mean use of antipsychotics addressing unstable estimates due to small sample sizes in some states | ||
| 520 | |a RESULTS: A total of 20,867 AL residents with dementia were included in the analysis, contributing to 194,718 person-months of observation. On average, AL residents with dementia were prescribed antipsychotics during 12.6% of their person-months. This rate varied significantly by state, with a low of 7.8% (95% CI 5.9%-10.3%) for Hawaii to a high of 20.5% (95% CI 16.4%-25.3%) for Wyoming | ||
| 520 | |a CONCLUSIONS AND IMPLICATIONS: We observed significant state variation in the prescribing of antipsychotics among AL residents with dementia using national data. These variations may reflect differences in state regulations regarding the care for AL residents with dementia and suggest the need for further investigation to ensure high quality of care | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Antipsychotic agents | |
| 650 | 4 | |a assisted living facilities | |
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| 700 | 1 | |a Zullo, Andrew R |e verfasserin |4 aut | |
| 700 | 1 | |a Coe, Antoinette B |e verfasserin |4 aut | |
| 700 | 1 | |a Gerlach, Lauren B |e verfasserin |4 aut | |
| 700 | 1 | |a Daiello, Lori A |e verfasserin |4 aut | |
| 700 | 1 | |a Varma, Hiren |e verfasserin |4 aut | |
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| 700 | 1 | |a Bynum, Julie P W |e verfasserin |4 aut | |
| 700 | 1 | |a Shireman, Theresa I |e verfasserin |4 aut | |
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