Policy to Reduce Antipsychotic Use and Hospitalization of Nursing Home Residents With Dementia.
Sijiu Wang, Helena Temkin-Greener, Yeates Conwell and 1 others
PMID 32527648WHAT IT FOUND
After the National Partnership, which included state coalitions, education, research, and public reporting of nursing home antipsychotic use, residents with dementia had 0.7 percentage-point higher hospitalization risk relative to residents without dementia.
High prior antipsychotic homes showed a relative increase of 1.2 percentage points.
Key findings
01After adjustment for resident characteristics and nursing home characteristics that stayed constant over time, residents with ADRD had a 0.7 percentage-point increase in hospitalization risk relative to residents without ADRD after the National Partnership.
02In homes with high baseline antipsychotic use, the relative change in hospitalization probability for residents with ADRD increased 1.2 percentage points (p=0.037); in low-use homes it increased 0.6 percentage points (p=0.22).
03Overall all-cause hospitalization rates decreased after the launch of the National Partnership, but the decrease was 0.8 percentage points greater for residents without ADRD than for residents with ADRD.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The policy applied nationwide, so there were no nursing homes that were naturally not exposed to it. The National Partnership had several components, so the study could not tell which component, if any, changed hospitalization risk. Dementia diagnosis came from nursing home assessments and may be underreported or inaccurate. The study did not determine whether the hospitalizations were necessary or avoidable. The findings apply to long-stay nursing home residents and may not apply to residents in post-acute skilled nursing facilities. Because this was an observational study, it cannot prove that antipsychotic reduction caused the increase in hospitalization risk.
Declared interests
The article is listed as supported by NIH extramural research funding. The supplied text does not include a conflicts of interest declaration.
The easy way to misread this
Do not conclude that reducing antipsychotic use caused more hospitalizations among residents with dementia. The study had no untreated comparison nursing homes, the National Partnership included several components, and the analysis could not separate which component changed outcomes.