31. THE BURDEN OF TARDIVE DYSKINESIA IN LONG-TERM CARE SETTINGS: RESULTS FROM A REAL-WORLD STUDY OF UNITED STATES CLAIMS DATA

Introduction

Tardive dyskinesia (TD), a persistent movement disorder associated with antipsychotic exposure, can have disabling impacts on social, physical, and emotional functioning. Older adults have a higher risk for TD and may be particularly vulnerable to its physical impacts (e.g., difficulty swallowing), potentially complicating clinical management in long-term care (LTC) settings. However, data on the prevalence and burden of TD in LTC settings are limited. Therefore, a real-world study was conducted using United States (US) claims data to characterize patients with TD in LTC settings.

Methods

The STATinMED Real-World Data Insights Database, which captures 80% of US claims data, was used for analysis. The study period was defined as Jan 2016-Dec 2022 (inclusive). Patients with ≥1 LTC stay and an ICD-10 code indicative of TD (G24.01) during the study period were identified and analyzed descriptively by LTC setting for each LTC stay during the study period. Additional analyses related to comorbidities, medication use, and healthcare visits were analyzed descriptively in a subpopulation of patients who met a more stringent set of inclusion criteria: ≥1 LTC stay from Jan 2017 to Dec 2021 (identification period), with “index stay” defined as the first LTC stay; ICD-10 code of G24.01 on or before the index stay; and continuous capture of medical and pharmacy benefits for 1 year pre-index stay and 1 year post-index stay.

Results

20,183 patients had an ICD-10 code indicative of TD and ≥1 LTC stay during the study period. Skilled nursing facilities were the most common type of LTC stay, with 14,235 (70.5%) patients having ≥1 skilled nursing facility stay during the study period. LTC stays in nursing homes (55.2%) and assisted living facilities (20.4%) were also common. Among 2,294 patients who met the criteria for additional analysis, 1,483 (64.6%) were ≥65 years and 1,544 (67.3%) were female. The mean (±SD) Charlson Comorbidity Index (CCI) score was 3.72 (±4.2), and 753 (32.8%) had a CCI score ≥4, indicating high comorbidity burden and increased mortality risk. Common comorbidities included mood disorders (66.1%), schizophrenia (38.8%), sleep disorders (35.0%), substance abuse (28.4%), urinary tract infections (26.7%), and dysphagia (18.5%). The use of antidepressants (56.1%), anticonvulsants (52.3%), antipsychotics (50.4%), and anticholinergics (50.0%) was common. Moreover, polypharmacy was common, with 47.9% of patients being prescribed ≥3 medications that may increase risk of falls or cognitive impairment in elderly adults (e.g., anticholinergics, anticonvulsants, antihistamines, benzodiazepines, sedative-hypnotics). Within 1 year after the index LTC stay, 1,085 (47.3%) patients had ≥1 emergency department (ED) visit, with a median of 2 visits/patient and median time to first visit of 143 days. Additional longitudinal real-world analyses on anticholinergic use, the prevalence of slips and falls, and healthcare resource utilization are currently being performed.

Conclusions

In this analysis of real-world claims data, skilled nursing facilities were the most common type of LTC stay for patients with TD. Patients with TD in LTC settings tended to be older and have high comorbidity burden and polypharmacy. Use of medications that cause TD (antipsychotics) or worsen TD (anticholinergics) was common, as were ED visits. These data indicate a need for special attention to the clinical burdens and pharmacological treatments of patients with TD in LTC settings, particularly older adults.