Impact of second-generation antipsychotics on the use of antiparkinson agents in nursing homes and assisted-living facilities
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
UMass Chan Affiliations
Meyers Primary Care InstituteDepartment of Medicine, Division of Geriatric Medicine
Document Type
Journal ArticlePublication Date
2006-03-30Keywords
AgedAged, 80 and over
Antiparkinson Agents
Antipsychotic Agents
*Assisted Living Facilities
Cross-Sectional Studies
Drug Utilization
Female
*Homes for the Aged
Humans
Male
Medicare
*Nursing Homes
Retrospective Studies
Geriatrics
Health Services Research
Primary Care
Metadata
Show full item recordAbstract
BACKGROUND: It is not known whether the reduced risk of motor adverse effects with second-generation antipsychotics (SGAPs) translates into less use of antiparkinson drugs (APDs). OBJECTIVE: This study sought to estimate national rates of concomitant prescribing of APDs and antipsychotic drugs among elderly Medicare beneficiaries without Parkinson's disease (PD) who were residing in institutional settings from 1997 to 2000, a period during which the use of SGAPs increased greatly. METHODS: This was a retrospective, cross-sectional, descriptive analysis using the Medicare Current Beneficiary Survey database. The population of interest was residents of nursing homes (NHs) and assisted-living facilities (ALFs) who received concomitant antipsychotic drugs and APDs but did not have PD. The primary objective of the study was to estimate the prevalence of concomitant APD and antipsychotic drug use for each study year, by use of first-generation antipsychotics (FGAPs) and SGAPs in each setting. A secondary objective was to compare concomitant use of APDs and individual antipsychotic agents (ie, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, haloperidol, and thioridazine). We computed population-level annual prevalence rates for APD use and tested for statistically significant differences in APD use between FGAPs and SGAPs at the 5% significance level. RESULTS: In NH residents, concomitant use of APDs and antipsychotics decreased from 20.7% in 1997 to 9.0% in 2000 (P < 0.005). APD use in NH residents declined similarly among users of FGAPs (from 23.2% in 1997 to 13.3% in 2000; P < 0.005) and SGAPs (from 18.4% in 1997 to 8.1% in 2000; P < 0.005). In ALF residents, concomitant use of APDs and antipsychotics decreased from 24.5% in 1997 to 21.1% in 2000 (P < 0.005). ADP use in ALF residents receiving FGAPs decreased from 26.9% in 1997 to 24.2% in 2000 (P < 0.005); there was no significant change in ADP use among ALF residents receiving SGAPs (from 21.0% in 1997 to 21.7% in 2000). CONCLUSIONS: These results provide the first nationally representative estimate of the concomitant use of APDs and antipsychotic drugs among older individuals in long-term care settings. The decrease in concomitant use of APDs and antipsychotics when SGAPs were used in NHs suggests an association between the use of SGAPs and a reduction in the prescribing cascade, in which one drug is used to treat the adverse effects of another. The results also suggest that some Medicare beneficiaries in ALFs may be continued on APDs despite changes in the prescribing of antipsychotic agents, implying a need for better medication-management practices in these institutions.Source
Am J Geriatr Pharmacother. 2006 Mar;4(1):25-35. Link to article on publisher's siteDOI
10.1016/j.amjopharm.2006.03.003Permanent Link to this Item
http://hdl.handle.net/20.500.14038/37000PubMed ID
16730618Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.amjopharm.2006.03.003