Effects of Nursing Home Changes in Antipsychotic Use on Outcomes among Residents with Dementia.

This was an observational target trial emulation, not a real randomized trial, and residual confounding cannot be ruled out. Facilities, not individual residents, were classified by antipsychotic use change, so a resident in a decreasing facility could have stopped, started, continued, or never received antipsychotics. Results may not apply to short-stay nursing home residents or residents covered by Medicare Advantage rather than Medicare fee-for-service. Only a smaller set of covariates was adjusted for, leaving facility culture, quality initiatives, prescriber experience, and other resident-level factors unmeasured. Facilities were not required to maintain their assigned antipsychotic-use pattern during follow-up, so effects of continuing to decrease versus maintain or increase use are uncertain. The 3,114,287 count is resident-trials, a unique instance of a resident in a particular target trial, not necessarily a simple count of distinct people.

The article lists research support from N.I.H. extramural and non-U.S. government sources. Competing interests: A.R.Z. reports prior grants from Sanofi paid directly to Brown University for collaborative research on the epidemiology of infections and vaccinations in nursing home residents. No other authors report conflicts relevant to the subject matter.

Do not conclude that reducing antipsychotic use in a nursing home is a safe or effective way to improve dementia resident outcomes. The study found no lower mortality or hospitalization risk, some slightly higher risks, and increased use of other psychotropic medications.