Antipsychotic Drug Use from Acute Care Admission to Discharge and 1 Month Post Discharge Among Older Adults Living with Dementia.

Abstract

Given the persistent use of antipsychotics during hospitalization and continued use post discharge, there is a need to consider alternative treatment options. The purpose of this study was to evaluate the use of antipsychotics in a sample of hospitalized older adults living with dementia and determine if exposure to Function Focused Care resulted in a decrease in antipsychotic use between admission, discharge, and 1 month post hospitalization. This was a secondary data analysis using data from the study Testing the Effectiveness of the Function Focused Care for Acute Care Study Using the Evidence Integration Triangle (FFC-AC-EIT). A total of 455 residents from 12 nursing homes in two states were included in the study. Sites were randomized to FFC-AC-EIT versus Education Only. The mean age of the participants was 82 years (Standard deviation [SD] = 8.5) and the majority was female (63%), White older adults (65%), married (36%), with high school or more education (81%), and moderate to severe cognitive impairment based on a Saint Louis University Mental Status Exam score of 7.5 (SD = 6.0). Overall, on admission, 17% were on an antipsychotic medication, at discharge, this increased to 21%, and at 1 month, it decreased to 19%. The repeated-measure analysis showed there was a significant difference in antipsychotic use between treatment groups over time (Pillai's Trace of .05, F = 8.9, p = .001). The intervention group increased in usage from 15% on admission to 23% at discharge and decreased to 18% at 1-month post discharge. Conversely, the control group remained essentially the same over time at 20% on admission and discharge and 21% at 1-month post discharge. The findings from this study confirm that there continues to be use of antipsychotics during hospital admissions, and individuals are still discharged on these medications and continued on these medications over time. There was no evidence to support the value of our FFC-AC-EIT in terms of decreasing the use of antipsychotics over time. Future research is needed to develop interventions focused on decreasing the use of antipsychotics.