Long-Stay Mood Stabilizer Use Increasing as Prescription of Antipsychotics Decreases
Abstract
Abstract. This retrospective cohort analysis of claims data used logistic regression to evaluate change in antipsychotic and antiepileptic mood stabilizer prescription frequencies in Virginia nursing homes among residents with and without seizure-epilepsy between the years 2011 and 2016. Over that period, prescription of antipsychotics decreased 13.1% to 5.6% in the long-stay population, while the use of antiepileptic mood stabilizers increased significantly 27.0%, to an 8.6% prevalence rate. These gains were entirely among residents without epilepsy. African-Americans and males were at significantly increased risk for the prescription of mood stabilizers. Growth in long-stay antiepileptic mood stabilizer use is unrelated to seizure-epilepsy, as these changes in prescription occurred only among residents without seizure-epilepsy. More antiepileptic mood stabilizers are now being prescribed to nursing-home residents without epilepsy than antipsychotics in the nursing-home population overall.
References
. (2020). http://www.vhi.org/apcd
(2011). Gabapentin in the treatment of dementia-associated nocturnal agitation. Medical Science Monitor, 17(12), CS149–151.
(2018). Sequential drug treatment algorithm for agitation and aggression in Alzheimer’s and mixed dementia. Journal of Psychopharmacology, 32(5), 509–523. https://doi.org/10.1177/0269881117744996
(2016). CDC guideline for prescribing opioids for chronic pain – United States, 2016. Journal of the American Medical Association, 315(15), 1624–1645. https://doi.org/10.1001/jama.2016.1464
(2020). Inappropriate antipsychotic use: The impact of nursing home socioeconomic and racial composition. Journal of the American Geriatrics Society, 68(3), 630–636. https://doi.org/10.1111/jgs.16316
(2012). Incidence and prevalence of epilepsy among older US Medicare beneficiaries. Neurology, 78(7), 448–453. https://doi.org/10.1212/WNL.0b013e3182477edc
(2011). The care span: Growth of racial and ethnic minorities in US nursing homes driven by demographics and possible disparities in options. Health Affairs (Millwood), 30(7), 1358–1365. https://doi.org/10.1377/hlthaff.2011.0126
(2020). Trends in antipsychotic and mood stabilizer prescribing in long-term care in the US: 2011–2014. Journal of the American Medical Directors Association, 21(11), 1629–1635.e1628. https://doi.org/10.1016/j.jamda.2020.05.039
(2018). An update on the prevalence and incidence of epilepsy among older adults. Epilepsy Research, 139, 107–112. https://doi.org/10.1016/j.eplepsyres.2017.11.022
(2018). Primary care physician perspectives about antipsychotics and other medications for symptoms of dementia. Journal of the American Board of Family Medicine, 31(1), 9–21. https://doi.org/10.3122/jabfm.2018.01.170230
(2018). Caregiver perspectives about using antipsychotics and other medications for symptoms of dementia. Gerontologist, 58(2), e35–e45. https://doi.org/10.1093/geront/gnx042
(2008). Anticonvulsants for the treatment of behavioral and psychological symptoms of dementia: A literature review. International Psychogeriatrics, 20(2), 293–308. https://doi.org/10.1017/S1041610207006540
(2018). Association of the Centers for Medicare & Medicaid Services’ national partnership to improve dementia care with the use of antipsychotics and other psychotropics in long-term care in the United States from 2009 to 2014. JAMA Internal Medicine, 178(5), 640–647. https://doi.org/10.1001/jamainternmed.2018.0379
(2006). Facility and county effects on racial differences in nursing home quality indicators. Social Science & Medicine, 63(12), 3046–3059. https://doi.org/10.1016/j.socscimed.2006.08.003
(2004). Driven to tiers: Socioeconomic and racial disparities in the quality of nursing home care. The Milbank Quarterly, 82(2), 227–256. https://doi.org/10.1111/j.0887-378X.2004.00309.x
. (2020). https://data.medicare.gov/data/archives/nursing-home-compare
. (2018). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021446s035,022488s013lbl.pdf
(2019). Disparities in nursing home use and quality among African American, Hispanic, and white Medicare residents with Alzheimer’s disease and related dementias. Journal of Aging and Health, 31(7), 1259–1277. https://doi.org/10.1177/0898264318767778
(2000). Treatment of dementia-associated agitation with gabapentin. Journal of Neuropsychiatry and Clinical Neurosciences, 12(1), 40–43. https://doi.org/10.1176/jnp.12.1.40
(2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. Journal of the American Medical Association, 293(5), 596–608. https://doi.org/10.1001/jama.293.5.596
(1997). An overview of nursing homes and their current residents: Data from the 1995 National Nursing Home Survey. Advance Data, 280), 1–12.
(2019). Gabapentin and pregabalin to treat aggressivity in dementia: A systematic review and illustrative case report. British Journal of Clinical Pharmacology, 85(4), 690–703. https://doi.org/10.1111/bcp.13844
(2012). Mood stabilizers for the treatment of behavioral and psychological symptoms of dementia: An update review. Kaohsiung Journal of Medical Science, 28(4), 185–193. https://doi.org/10.1016/j.kjms.2011.10.025
(2020). The prevalence and factors associated with antiepileptic drug use in US nursing home residents. Drugs Aging, 37(2), 137–145. https://doi.org/10.1007/s40266-019-00732-2
