Use of Antipsychotics among Elderly Nursing Home Residents with Dementia in the US An Analysis of National Survey Data

Background: Atypical antipsychotic agents are increasingly being used for the treatment of behavioural and psychological symptoms of dementia. However, recent data suggest that the risk of adverse effects may offset the benefits of atypical agents in patients with dementia. Objectives: To examine utilization of antipsychotic medications and the factors associated with use of atypical antipsychotics among elderly nursing home residents with dementia. Methods: The study involved the analysis of prescription and resident files of a nationally representative sample of residents from the 2004 National Nursing Home Survey (NNHS). The study sample included an unweighted sample of 6103 elderly nursing home residents aged >= 65 years with dementia. The analysis focused on the use of six atypical antipsychotic agents and 11 typical agents. Descriptive weighted analysis was performed to examine the antipsychotic prevalence patterns in elderly nursing home residents with dementia. Multiple logistic regression analysis within the conceptual framework of Andersen's Behavioural Model was used to examine the predisposing, enabling and need characteristics associated with use of atypical antipsychotics. Results: According to the 2004 NNHS, the overall prevalence of dementia among elderly nursing home residents was 52.58%. Most of the elderly with dementia were female (77%), aged >= 85 years (56%), non-Hispanic (97%) and White (88%). Antipsychotic medications were taken by 32.88% of elderly patients with dementia. More elderly residents received atypical agents (31.63%) than typical agents (1.75%). Among the predisposing characteristics, the odds of receiving atypical antipsychotics were lower for females than males. The enabling factor facility bed capacity was significantly associated with use of atypical antipsychotics. Among the need characteristics, the likelihood of receiving atypical antipsychotic agents increased with dependence in decision-making ability, indicators of depressed mood and behavioural symptoms. The likelihood of receiving atypical antipsychotic agents decreased with increasing dependence for out-of-bed mobility and increased total activities of daily living. The odds of receiving atypical antipsychotic treatment increased with the diagnosis of schizophrenia, bipolar mania and anxiety among dementia patients. Conclusion: Nearly one-third of elderly nursing home residents with dementia received antipsychotic medications, mainly atypical agents. Predisposing, enabling and need factors influenced the use of atypical agents in dementia patients. These findings suggest a need to optimize use of atypical antipsychotics in elderly dementia patients in nursing homes in the light of recent efficacy and safety data.