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Health Policy. 2015 Jun;119(6):802-13. doi: 10.1016/j.healthpol.2015.02.014. Epub 2015 Feb 28.

A literature review of clinical outcomes associated with antipsychotic medication use in North American nursing home residents.

Author information

1
School of Pharmacy, University of California, San Francisco, 513 Parnassus Ave., San Francisco, CA 94143, USA. Electronic address: yunwen.chiu@gmail.com.
2
Department of Clinical Pharmacy, University of California, San Francisco, 3333 California St. Suite 420, San Francisco, CA 94143, USA; Institute for Health Policy Studies, University of California, San Francisco, 3333 California St. Suite 420, San Francisco, CA 94143, USA. Electronic address: lisa.bero@sydney.edu.au.
3
Department of Clinical Pharmacy, University of California, San Francisco, 3333 California St. Suite 420, San Francisco, CA 94143, USA; Department of Medicine, University of California, San Francisco, 3333 California St. Suite 420, San Francisco, CA 94143, USA. Electronic address: Nancy.Hessol@ucsf.edu.
4
School of Health Policy and Management, York University, 4700 Keele St., Toronto, ON, Canada M3J 1P3. Electronic address: jlexchin@yorku.ca.
5
Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California St., Suite 410, San Francisco, CA 94143, USA. Electronic address: charlene.harrington@ucsf.edu.

Abstract

The benefits and harms of antipsychotic medication (APM) use in nursing home residents need to be examined because, although commonly used, APMs are considered an off-label use by the Food and Drug Administration for residents with dementia and behavioral problems. The objective of this study was to provide a realist literature review, summarizing original research studies on the clinical effects of conventional and atypical APM use in nursing home residents. Searches of multiple databases identified 424 potentially relevant research articles, of which 25 met the inclusion criteria. Antipsychotic medication use in nursing home residents was found to have variable efficacy when used off-label with an increased risk of many adverse events, including mortality, hip fractures, thrombotic events, cardiovascular events and hospitalizations. Findings suggested certain APM dosing regimens (e.g. fixed-dose) and shorter duration of use might have fewer adverse events. Non-pharmacological interventions should still be considered the first-line treatment option for nursing home residents with dementia related behavioral disturbances, as more studies are needed to establish safer criteria for APM use in nursing homes residents.

KEYWORDS:

Adverse effects; Antipsychotic agents; Nursing home; Outcome assessment; Policy

PMID:
25791166
DOI:
10.1016/j.healthpol.2015.02.014
[Indexed for MEDLINE]

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