Abstract
Objective
In nursing homes (NHs), psychoactive medication use has received notable attention,
but less is known about prescribing in assisted living (AL). This study examined how
antipsychotic and antianxiety medication prescribing in AL compares with NHs.
Design
Observational, cross-sectional AL data linked to publicly reported NH measures.
Setting and Participants
Random sample of 250 AL communities and the full sample of 3371 NHs in 7 states.
Methods
We calculated the percentage of residents receiving antipsychotics and antianxiety
medications. For each AL community, we calculated the distance to NHs in the state.
Linear models estimated the relationship between AL prescribing and that of the closest
and farthest 5 NHs, adjusting for AL characteristics and state fixed effects.
Results
The prescribing rate of potentially inappropriate antipsychotics (i.e., excluding
for persons with recorded schizophrenia and Tourette syndrome) and of antianxiety
medications (excluding for those on hospice) in AL was 15% and 21%, respectively.
Unadjusted mean antipsychotic prescribing rates were nominally higher in AL than NHs
(14.8% vs 14.6%; P = .056), whereas mean antianxiety prescribing was nominally lower in AL (21.2% vs
22.6%; P = .032). In adjusted analyses, AL rates of antipsychotic use were not associated
with NH rates. However, being affiliated with an NH was associated with a lower rate
of antipsychotic use [b = −0.03; 95% confidence interval (CI) −0.50 to −0.001; P = .043], whereas antianxiety rates were associated with neighboring NHs’ prescribing
rates (b = 0.43; 95% CI 0.16–0.70; P = .002).
Conclusions and Implications
This study suggests reducing antipsychotic medication use in NHs may influence AL
practices in a way not accounted for by local NH patterns. And, because antianxiety
medications have not been the focus of national campaigns, they may be more subject
to local prescribing behaviors. It seems advantageous to consider prescribing in AL
when efforts are implemented to change NH prescribing, as there seems to be related
influence whether by affiliation or region.
Keywords
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Article info
Publication history
Published online: December 28, 2020
Footnotes
The authors declare no conflicts of interest.
This work was supported by the National Institute on Aging (#AG050602 to SZ) and the U.S. Department of Veterans Affairs (CDA 14–422 to KST).
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
