State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia.

Only assisted living facilities with 25+ beds were identified by ZIP code, so smaller facilities were missed. Some residents in independent living sharing a ZIP code with an assisted living facility may have been included. Only fee-for-service Medicare beneficiaries were included. Medicare Advantage residents were not, although they accounted for 40% of Medicare beneficiaries in assisted living in 2017. The claims did not include dementia severity, behavioral symptoms, or reasons for prescribing, so the study cannot say whether antipsychotic use was appropriate. The data were from 2017, so they may not reflect recent state policies or post-pandemic practice. The study did not examine within-state differences in licensure, local prescribing patterns, or patient outcomes.

Do not read the state variation as proof that more or less antipsychotic prescribing is safer or more appropriate. The study counted filled prescriptions in 2017 Medicare claims and did not measure dementia symptoms, prescribing reasons, or patient outcomes.