Factors Associated with Potentially Harmful Medication Prescribing in Nursing Homes: A Scoping Review.
Jessica P Lipori, Emily Tu, Theresa I Shireman and 3 others
PMID 35868350WHAT IT FOUND
US nursing-home studies found higher antipsychotic use was associated with facilities having more severe cognitive impairment, anxiety, depression, aggressive behavior or post-traumatic stress disorder and with lower RN hours or for-profit ownership.
The review found no tested way to reduce these medications.
Key findings
01The most consistent associations with antipsychotic use were facility case mix, including higher proportions of non-White patients and more severe cognitive impairment, anxiety, depression, aggressive behavior, and post-traumatic stress disorder.
02Lower registered nurse hours per resident day and for-profit ownership were associated with greater antipsychotic use, but special care unit findings were inconsistent.
03Only one study reported prescriber-level differences, and it did not examine specific prescriber characteristics.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
All included studies were observational, and none was a randomized trial, so the review cannot show that changing a facility factor would reduce harmful medication use. Many studies did not distinguish clinically appropriate from inappropriate antipsychotic prescribing. Findings about patient sex, race, age, insurance and functional status were inconsistent across studies. Only 2 studies analyzed data from within the past 5 years. The 3 studies with prospective elements had small samples, self-report, and low response rates as low as 30%. Prescriber characteristics were almost absent, with only one study reporting a difference between psychiatric consulting groups. The review was limited to studies conducted in the United States and written in English. The included studies were too diverse to combine into one overall estimate. The review did not cover deprescribing tools such as Stopp/Start.
Declared interests
The article is tagged as supported by extramural NIH research. The supplied text does not include a conflicts-of-interest declaration or a statement that a sponsor designed or wrote the study.
The easy way to misread this
Do not read lower RN hours, for-profit ownership or special care units as causes of higher antipsychotic prescribing. The review only combined observational studies, many findings were inconsistent, and no intervention was tested.