The variability of prescribing antipsychotic drugs in nursing homes
The March International Psychogeriatrics Article of the Month is entitled ‘Variability between nursing homes in prevalence of antipsychotic use in patients with dementia’ by Bart C. Kleijer, Rob J. van Marum, Dinnus H. M. Frijters et al.
Patients with dementia are often treated with antipsychotic drugs (APD) to alleviate behavioural symptoms, even though there is little evidence of their efﬁcacy for this indication and it has never been shown that long-term APD therapy in patients with dementia positively inﬂuences quality of life.
Despite uncertainties about the beneﬁts and risks of APDs in the elderly, the prevalence of APD use in the elderly population remains high, especially in long term care facilities (LTCF) globally.
The objective of the authors’ study was to examine if differences in facility-level prevalence of APD use in a sample of LTCFs for patients with dementia can be explained by patient and facility-related characteristics.
In total, 20 LTCFs in The Netherlands providing care for 1,090 patients with dementia were investigated. Overall, 31% of patients used an APD. Facilities with a high prevalence of APD use were often large, situated in urban communities, and scored below average on stafﬁng, personal care, and recreational activities.
There was considerable variation between the participating LTCFs in the prevalence of APD use. Variability was related to LTCF characteristics and patient satisfaction. This indicated potential inappropriate prescribing because of differences in institutional prescribing culture.
Alice Bonner, the commentary paper author observed, “The authors make the point that in many countries, rates of APD use in people with dementia living in nursing homes are high nationally, despite a documented lack of efficacy of these drugs in this population. This presents a golden opportunity for the international dementia care community to come together and actively promote and test person-centered, individualized solutions and new models of nursing home care.”