Antoinette B. Coe PharmD, PhD, Tingting Zhang MD, PhD, Andrew R. Zullo PharmD, PhD, Lauren B. Gerlach DO, MS, Lori A. Daiello PharmD, ScM, Hiren Varma MS, Derrick Lo ScM, Richa Joshi MS, Julie P. W. Bynum MD, MPH, Theresa I. Shireman PhD
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We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Among community-dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee-for-service claims using interrupted time series analyses across three periods (“Pre-Partnership”: July 1, 2010 to March 31, 2012; “Post-Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We included 1,289,401 community dwellers with dementia contributing 26,609,697 person-months. The mean age was 80 years, most were female (70%), approximately 80% were non-Hispanic Whites, 10% were non-Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre-Partnership (<i>β</i> = −0.06, 95% CI: −0.08, −0.05) and post-Partnership (<i>β</i> = −0.02, 95% CI: −0.02, −0.01). Post-Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (<i>β</i> = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community-dwelling older adults with dementia.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community-dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community-dwellers with dementia.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"214-222"},"PeriodicalIF":4.3000,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734101/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association of nursing home antipsychotic reduction policies with antipsychotic use in community dwellers with dementia\",\"authors\":\"Antoinette B. Coe PharmD, PhD, Tingting Zhang MD, PhD, Andrew R. Zullo PharmD, PhD, Lauren B. Gerlach DO, MS, Lori A. Daiello PharmD, ScM, Hiren Varma MS, Derrick Lo ScM, Richa Joshi MS, Julie P. W. Bynum MD, MPH, Theresa I. 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The mean age was 80 years, most were female (70%), approximately 80% were non-Hispanic Whites, 10% were non-Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre-Partnership (<i>β</i> = −0.06, 95% CI: −0.08, −0.05) and post-Partnership (<i>β</i> = −0.02, 95% CI: −0.02, −0.01). Post-Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (<i>β</i> = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community-dwelling older adults with dementia.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community-dwelling older adults with dementia. 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Association of nursing home antipsychotic reduction policies with antipsychotic use in community dwellers with dementia
Background
Antipsychotic and other psychotropic medication use is prevalent among community-dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (“the Partnership”) and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.
Methods
Among community-dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee-for-service claims using interrupted time series analyses across three periods (“Pre-Partnership”: July 1, 2010 to March 31, 2012; “Post-Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).
Results
We included 1,289,401 community dwellers with dementia contributing 26,609,697 person-months. The mean age was 80 years, most were female (70%), approximately 80% were non-Hispanic Whites, 10% were non-Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre-Partnership (β = −0.06, 95% CI: −0.08, −0.05) and post-Partnership (β = −0.02, 95% CI: −0.02, −0.01). Post-Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (β = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community-dwelling older adults with dementia.
Conclusions
These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community-dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community-dwellers with dementia.
期刊介绍:
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.