Use of antipsychotics, but not opioids, drops in nursing home residents with dementia

Prescription of antipsychotic and anxiolytic medications has decreased among residents with dementia in Veterans Health Administration (VHA) nursing homes, but overall prescribing of other psychotropic and opioid agents has increased, reports a study.

“Policies focused primarily on reducing antipsychotic use without considering use in the context of other medications may contribute to growth in alternative medication classes with even less evidence of benefit and similar risks,” the investigators said.

A total of 35,742 veterans with dementia residing in VHA nursing homes for more than 30 days were included in the analysis. The investigators assessed the quarterly prevalence of antipsychotic, antidepressant, antiepileptic, anxiolytic, opioid, and memory medication prescribing from 2009 through 2018 using an interrupted time-series design.

Antipsychotic prescribing in VHA nursing homes dropped from 33.7 percent in 2009 to 27.5 percent in 2018, as did anxiolytic prescribing (from 33.5 percent to 27.1 percent).

However, prescribing of antiepileptics (from 26.8 percent to 43.3 percent), antidepressants (from 56.8 percent to 63.4 percent), and opioids (from 32.6 percent to 41.2 percent) significantly rose during the same period.

Increases in antiepileptic prescribing was mainly driven by gabapentin (from 11.1 percent to 23.5 percent), while that in antidepressant prescribing included sertraline, mirtazapine, and trazodone.

Additionally, the overall prescribing of nonantipsychotic psychotropic medications rose from 75.0 percent in 2009 to 81.1 percent in 2018.

“The VHA and the Centers for Medicare and Medicaid Services (CMS) each created initiatives to reduce off-label use of antipsychotics in patients with dementia in nursing homes,” the investigators said, noting reductions in antipsyhotic prescribing in CMS.