Antiepileptic prescriptions are on the rise in nursing homes, while those for antipsychotic and opioid drugs are declining, according to a new analysis of federal data.
Investigators tracked prescriptions among more than 970,000 long-stay nursing facility residents with Alzheimer’s disease and related dementias from 2015 to 2019. They examined antiepileptic prescription rates, and followed trends for certain drugs, including the antiepileptics valproic acid and gabapentin, as well as antipsychotics and opioids. Data came from Minimum Data Set and Medicare records, including Part D pharmacy claims.
The proportion of residents with dementia who were prescribed at least one antiepileptic rose from 29.5% in 2015 to 31% in 2019. Driving the increase in antiepileptics with valproic acid and gabapentin driving the increase, the researchers reported. At the same time, antipsychotic prescribing rates fell from 32% to 28% and opioid prescribing rates declined from 40% to 32%.
Clinicians appeared to be using the different antiepileptics to address distinct issues, noted Donovan T. Maust, MD, MS, of the University of Michigan. Valproic acid prescribing was 11 percentage points higher among residents who had disruptive behaviors, while the odds of being prescribed gabapentin were 14 percentage points higher among residents who reported pain.
Although antiepileptics are commonly prescribed to nursing home residents with dementia, there is little scientific support for their use in this population, Maust and colleagues noted.
“Antiepileptic prescribing of questionable risk–benefit for dementia care warrants further scrutiny,” they concluded.
Full findings were published in the Journal of the American Geriatrics Society.
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