Levels of Drug Prescribing for Patients With Alzheimer Disease Connected to NH Characteristics

Study authors recently assessed the connection between nursing home (NH) characteristics and the level of opioid, antipsychotic, or benzodiazepine prescribing for patients with Alzheimer disease (AD) and related dementias.

“The overlap between antipsychotic and benzodiazepine prescribing and our finding that some NH characteristics were consistently associated with prescribing across drug classes may support the idea of an organizational culture of prescribing in NHs, which could inform efforts to improve prescribing quality in NHs,” wrote researchers in the Journal of the American Medical Directors Association.

The retrospective, cross-sectional analysis included 448,128 Medicare beneficiaries who were diagnosed with AD-related dementias and resided in 13,151 NHs in 2017. Researchers extracted data from Medicare claims, LTCFocus, and the Minimum Data Set to determine the amount of NH residents with AD-related dementias who in 2017 filled ≥1 antipsychotic, benzodiazepine, or opioid prescription.

Study authors determined which NH characteristics were associated with being in the top or bottom quartile of the prescribing distribution for each drug class.
According to the data, an average of 29.1 % of residents with AD-related dementias received an antipsychotic, 30.2% received a benzodiazepine, and 40.9% received an opioid.

Findings showed NHs with a larger amount of registered nursing care were more likely to be bottom-quartile prescribers, while NHs with a larger share of Medicaid-enrolled residents and smaller NHs were more likely to be top-quartile prescribers. 

“Our results also highlight benzodiazepine and opioid use for AD-related dementias, which were more commonly prescribed than antipsychotics in NHs but have received less regulatory attention,” concluded researchers.

Reference:
Candon M, Strominger J, Gotlieb E, Maust DT. Nursing home characteristics associated with high and low levels of antipsychotic, benzodiazepine, and opioid prescribing to residents with Alzheimer disease and related dementias: a cross-sectional analysis. J Am Med Dir Assoc. Published online June 27, 2022. doi:10.1016/j.jamda.2022.05.025