Rationales that providers and family members cited for the use of antipsychotic medications in nursing home residents with dementia
Meyers Primary Care Institute; Department of Quantitative Health Sciences
Geriatrics | Mental and Social Health | Mental Disorders | Psychiatric and Mental Health
OBJECTIVES: To describe the rationales that providers and family members cite for the use of antipsychotic medications in people with dementia living in nursing homes (NHs).
DESIGN: Qualitative, descriptive study.
SETTING: Twenty-six medium-sized and large facilities in five Centers for Medicare and Medicaid Services regions.
PARTICIPANTS: Individuals diagnosed with dementia who received an antipsychotic medication.
MEASUREMENTS: Data were collected from medical record abstraction and interviews with prescribers, administrators, direct care providers, and family members. Textual data from medical record abstraction and responses to open-ended interview questions were analyzed using directed content analysis techniques. A coding scheme was developed, and coded reasons for antipsychotic prescribing were summarized across all sources.
RESULTS: Major categories of reasons for use of antipsychotic medications in the 204 NH residents in the study sample were behavioral (n = 171), psychiatric (n = 159), emotional states (n = 105), and cognitive diagnoses or symptoms (n = 114). The most common behavioral reasons identified were verbal (n = 91) and physical (n = 85) aggression. For the psychiatric category, psychosis (n = 95) was most frequently described. Anger (n = 93) and sadness (n = 20) were the most common emotional states cited.
CONCLUSION: The rationale for use of antipsychotic drug therapy frequently relates to a wide variety of indications for which these drugs are not approved and for which evidence of efficacy is lacking. These findings have implications for clinical practice and policy. Geriatrics Society.
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Citation: J Am Geriatr Soc. 2015 Feb;63(2):302-8. doi: 10.1111/jgs.13230. Epub 2015 Jan 30. Link to article on publisher's site
Bonner, Alice F.; Field, Terry S.; Lemay, Celeste A.; Mazor, Kathleen M.; Andersen, Daniel A.; Compher, Christina J.; Tjia, Jennifer; and Gurwitz, Jerry H., "Rationales that providers and family members cited for the use of antipsychotic medications in nursing home residents with dementia" (2015). Meyers Primary Care Institute Publications and Presentations. 716.