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J Am Geriatr Soc. 2015 Feb;63(2):302-8. doi: 10.1111/jgs.13230. Epub 2015 Jan 30.

Rationales that providers and family members cited for the use of antipsychotic medications in nursing home residents with dementia.

Author information

1
School of Nursing and Center for Health Policy, Northeastern University, Boston, Massachusetts.

Abstract

OBJECTIVES:

To describe the rationales that providers and family members cite for the use of antipsychotic medications in people with dementia living in nursing homes (NHs).

DESIGN:

Qualitative, descriptive study.

SETTING:

Twenty-six medium-sized and large facilities in five Centers for Medicare and Medicaid Services regions.

PARTICIPANTS:

Individuals diagnosed with dementia who received an antipsychotic medication.

MEASUREMENTS:

Data were collected from medical record abstraction and interviews with prescribers, administrators, direct care providers, and family members. Textual data from medical record abstraction and responses to open-ended interview questions were analyzed using directed content analysis techniques. A coding scheme was developed, and coded reasons for antipsychotic prescribing were summarized across all sources.

RESULTS:

Major categories of reasons for use of antipsychotic medications in the 204 NH residents in the study sample were behavioral (n = 171), psychiatric (n = 159), emotional states (n = 105), and cognitive diagnoses or symptoms (n = 114). The most common behavioral reasons identified were verbal (n = 91) and physical (n = 85) aggression. For the psychiatric category, psychosis (n = 95) was most frequently described. Anger (n = 93) and sadness (n = 20) were the most common emotional states cited.

CONCLUSION:

The rationale for use of antipsychotic drug therapy frequently relates to a wide variety of indications for which these drugs are not approved and for which evidence of efficacy is lacking. These findings have implications for clinical practice and policy.

KEYWORDS:

antipsychotic medication; dementia; nursing home

PMID:
25643635
DOI:
10.1111/jgs.13230
[Indexed for MEDLINE]

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