Drs. Judith A. Lucas and Stephen Crystal received a $244,170 award for their project, “Patterns and Guideline Consistency of Antipsychotic Drug Use in Nursing Homes,” from The Retirement Research Foundation. The project will examine the patterns of antipsychotic drug use in nursing facilities; measure adherence to federal antipsychotic drug prescribing guidelines; and model resident, facility, and community characteristics associated with prevalent and incident (new) episodes of antipsychotic use in the nursing home population. Widespread use of antipsychotic drugs in nursing homes especially for residents with behavioral symptoms of dementia is a critically important and controversial issue in nursing home care. Although the newer atypical antipsychotic medications have been widely perceived as safer compared to the older antipsychotics especially regarding the disabling extra-pyramidal symptoms, the frail elderly face significant adverse side effects. Recent studies also show that the risks are significant with both conventional and atypical antipsychotics, and that, among other risks, elevated death rates are observed among nursing home residents prescribed these drugs. Risks are likely to be increased when best practices such as minimizing dosages, limiting duration of treatment, and avoiding multiple-antipsychotic use are not followed. While the FDA has issued a black box warning about their use among the frail elderly, treatment with antipsychotics continues to be widespread. Information on practices of antipsychotic dosing is needed for guiding policies, educational efforts and quality improvement initiatives.
The study will utilize data from the nursing home Minimum Data Set (MDS) combined with data from Medicaid claims and other sources. The Institute’s Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes has developed this merged dataset as a resource to support a range of current and future studies related to prescription drug use and outcomes.