Psychotropic and psychoactive drugs and hospitalization rates in nursing facility residents

  • James W. Cooper
  • Megan H. Freeman
  • Christopher L. Cook
  • Alison H. Burfield
Keywords: Psychotropic Drugs, Skilled Nursing Facilities, Hospitalization, United States

Abstract

The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug “load” between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates.

Methods: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some177 patients resident for 30 or more days over a 19 month period of 2978 patient-months data were tabulated. A monthly repeated-measures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations.

Results: The rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation.

Conclusion: Preliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total “load” of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility.

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References

1. Aditya BS, Sharma JC, Allen SC, Vassallo M. Predictors of a nursing home placement from a non-acute geriatric hospital. Clin Rehabil 2003: 1:108-13.

2. Sloane PD, Mathew LJ, Scarborough M, Desai JR, Koch GG, Tangen C. Physical and pharmacologic restraints of nursing home patients with dementia. JAMA 1991;265:1278 82.

3.Buck JA. Psychotropic drug practice in nursing homes. J Am Geriatri Soc 1988;36:409 18.

4. Cooper JW, Cobb HH, Burfield AH. Buspirone conversion effect on falls, injuries, behavior and costs in a rural geriatric nursing home population. Consult Pharm 2001; 16(4):358-63.

5. Cooper JW. Consultant pharmacist assessment and reduction of fall risk in nursing facilities. Consult Pharm 1997; 12: 1294-304.

6. Cooper JW. Consultant pharmacist assessment of fall injury incidence and costs within a nursing facility. Consult Pharm 1997; 12: 1305-9.

7. Cooper JW. Reducing falls among patients in nursing homes. JAMA 1997;278: 1742.

8. Cooper JW. Adverse drug reaction-related hospitalizations of nursing facility patients: a 4-year study. South Med J 1999; 92:485-90.

9. Pitkala KH, Laurila JV, Strandberg TE, Tilvis RS. Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards. Int Psychogeriatri 2004:16(1): 61-74.

10. Teri L, Logsdon RG, Peskind E, Raskind M, Weiner MF, Tractenberg RE, Foster NL, Schneider LS, Sano M, Whitehouse P, Tariot P, Mellow AM, Auchus AP, Grundman M, Thomas RG, Schafer K, Thal LJ; Alzheimer's Disease Cooperative Study. Treatment of agitation in Alzheimers’s Dementia: a randomized placebo-controlled clinical trial. Neurology. 2000;55(9):1271-8.

11. Perri M 3rd, Menon AM, Deshpande AD, Shinde SB, Jiang R, Cooper JW, Cook CL, Griffin SC, Lorys RA. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother 2005;39(3):405-11.

12. Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Int Med 2005; 165:68-74.

13. Professional Package Insert materials for clozapine, olanzapine, quetiapine, risperidone, ziprasidone and aripiprazole, 2007.

14. Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH, Brookhart MA. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med 2005;353:2335-41.

15. Cooper JW, Horner MR, Cook CL, Burfield AH. Psychotropic and Psychoactive Drug Load Assessment and Falls in Nursing Facility Residents. Consult Pharm, 2007: 22:483-9.
Published
2007-09-10
How to Cite
1.
Cooper JW, Freeman MH, Cook CL, Burfield AH. Psychotropic and psychoactive drugs and hospitalization rates in nursing facility residents. Pharm Pract (Granada) [Internet]. 2007Sep.10 [cited 2019Jul.17];5(3):140-4. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/251
Section
Original Research