Federal Nursing Home Policies on Antipsychotics had Similar Impacts by Race and Ethnicity for Residents With Dementia.
Theresa I Shireman, Shekinah Fashaw-Walters, Tingting Zhang and 7 others
PMID 37127131WHAT IT FOUND
Federal dementia-care and Five-Star policies were associated with lower antipsychotic use among nursing home residents with dementia, and reductions were similar across race and ethnicity groups.
Key findings
01Antipsychotic exposure declined for all three groups between 2011 and 2017.
02Antipsychotic use declined significantly for non-Hispanic White residents, and the decline did not differ significantly for non-Hispanic Black or Hispanic residents.
03The Five-Star rating change was not associated with an initial change in antipsychotic use, but it slowed the decline among non-Hispanic White residents.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study measured medication exposure, not whether antipsychotics were appropriate or whether residents had falls, deaths, or other outcomes. The policies were not randomly assigned, and antipsychotic use was already declining after FDA warnings, so the study cannot prove the policies caused the reductions. MDS assessments do not record mood stabilizers such as gabapentin and valproic acid, so possible substitution to those drugs could not be assessed. Exclusionary diagnoses may have changed over time and by race, although the absolute increases were small. Other racial and ethnic minority groups were excluded because of small sample sizes.
Declared interests
The article is marked as supported by NIH extramural research; the supplied text does not report author conflicts of interest.
The easy way to misread this
Do not read the similar reductions as proof that the policies caused lower antipsychotic use or that residents received safer care. The study is observational and did not measure falls, mortality, or whether individual prescriptions were appropriate.