Background
Few studies have examined factors associated with antidepressant prescribing in older
nursing home residents.
Objective
The primary objective was to describe the change in antidepressant prescribing for
nursing home residents between 1996 and 2006. An additional objective was to examine
the association between any change in antidepressant prescribing and staffing patterns
or coprescribing of other psychotropic medications in the same cohort.
Design
Longitudinal.
Settings
Settings were 12,556 US nursing homes in 1996 and 2006.
Data Sources
Online Survey Certification and Reporting (OSCAR) data and the Area Resource File
(ARF).
Measurements
Increasing prescribing of antidepressants analyzed using multivariable multinomial
generalized estimating equations (GEE).
Results
Antidepressant prescribing significantly increased (P < .05) from 21.9% in 1996 to 47.5% in 2006. After controlling for resident, organizational,
and market factors, increased antidepressant prescribing was associated with more
time spent by physician extenders (adjusted odds ratio [AOR] 2.21; 95% confidence
interval [CI] 1.96–2.51), registered nurses (AOR 1.06, 95% CI 1.02–1.10), or nurse
aides (AOR 1.08; 95%CI 1.04–1.12) in a facility, as well as the coprescribing of sedative/hypnotics
(AOR 1.12; 95% CI 1.08–1.16). Factors found to be protective of increasing antidepressant
prescribing (ie, decrease antidepressant prescribing) included having medical directors
and physicians spend more time in the facility (AOR 0.60; 95% CI 0.53–0.69 and AOR
0.62; 95% CI 0.54–0.71, respectively), or coprescribing of antianxiety or antipsychotic
agents (AOR 0.70; 95% CI 0.68–0.72 and AOR 0.74; 95% CI 0.72–0.77, respectively).
Conclusions
Prescribing of antidepressants has increased dramatically in the past decade in older
nursing home residents and seems to be associated with certain staffing characteristics
and the coprescribing of psychotropic medications. Further research is needed to determine
if antidepressants are appropriately prescribed, and if overuse is determined, develop
interventions to improve the quality of prescribing of these medications in older
nursing home residents.
Keywords
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Article info
Footnotes
The authors have indicated that they have no other conflicts of interest regarding the content of this article. This study was supported by National Institute of Aging grants (R01AG027017, P30AG024827, T32 AG021885, K07AG033174, R01AG034056), a National Institute of Mental Health grant (R34 MH082682), a National Institute of Nursing Research grant (R01 NR010135), an Agency for Healthcare Research and Quality grant (R01 HS017695), a VA Health Services Research grant (IIR-06–062), and a NIH Roadmap Multidisciplinary Clinical Research Career Development Award Grant (K12 RR023267).
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© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
