Psychotropic Drug Consumption at Admission and Discharge of Nursing Home Residents

• Published in: Journal of the American Medical Directors Association Vol. 13; no. 4; pp. 407.e7 - 407.e12
• Main Authors: Rolland, Yves, MD, PhD, Andrieu, Sandrine, MD, PhD, Crochard, Anne, PhD, Goni, Sylvia, MD, Hein, Christophe, MD, Vellas, Bruno, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2012
• Subjects: Aged; Aged, 80 and over; care transitions; Cross-Sectional Studies; dementia; Dementia - diagnosis; Dementia - drug therapy; Dementia - epidemiology; Drug Utilization - statistics & numerical data; Female; Follow-Up Studies; France; Geriatric Assessment - methods; Homes for the Aged; Humans; Inappropriate Prescribing - statistics & numerical data; Internal Medicine; Male; Medical Education; Needs Assessment; Nursing Homes; Patient Admission - statistics & numerical data; Patient Discharge - statistics & numerical data; psychotropic drugs; Psychotropic Drugs - administration & dosage; Psychotropic Drugs - pharmacology; France; Nursing homes; dementia; psychotropic drugs; care transitions
• ISSN: 1525-8610; 1538-9375
• DOI: 10.1016/j.jamda.2011.12.056

Abstract Objectives To quantify transitions of residents into or out of nursing homes (NHs) and to describe psychotropic drug prescription at admission and discharge and with regard to dementia diagnosis. Design A descriptive, cross-sectional, noninterventional study. Setting The setting included 300 NH in France. Participants Participants included 2231 NH residents. Measurements Participants reported the number, origin, and destination of residents transiting into or out of the NH in the previous 3 months and provided information on NH characteristics. For eight residents admitted or discharged by the NH, information was collected on medical characteristics, including psychotropic and antidementia drug prescription, and dementia status. Results The mean number of beds in participating NHs was 85.9 ± 33.2 (mean occupation rate = 96.6%). The mean number of admissions and discharges in the previous 3 months was 13.7 ± 8.5 and 11.2 ± 4.3, respectively. Most admissions (direct admission 3.2 ± 3.3 or readmission 6.4 ± 6.0) and discharges (4.4 ± 6.7) were from and to the hospital. Of the 2231 residents included, 1005 (45.0%) were diagnosed with dementia. At least one psychotropic drug (antidepressant, hypnotic, antipsychotic, or anxiolytic) was prescribed to 70.7% of residents and in particular an antipsychotic to 19.1% of residents. Psychotropic drugs, and in particular antipsychotic drugs, were significantly more prescribed to demented residents than to nondemented residents (76.2% vs 64.3% and 28.0% vs 11.8%, respectively). The extent of prescription (at least one psychotropic drug) was similar in residents admitted to (70.2%) and discharged from (67.5%) the NHs. Antidementia drugs (acetylcholinesterase inhibitors or NMDA receptor antagonists) were prescribed to 53.7% of demented residents. Conclusion Movement of residents into and out of NHs and especially from and to the hospital is extensive and the prescription rate for psychotropic drugs is very high in this population, especially in residents with dementia. Multiple groups of health care providers should be targeted by educational measures to improve the quality of care for NH residents.