Following two key federal initiatives to reduce overreliance on antipsychotic medications in nursing homes, declining exposure has occurred evenly across resident racial and ethnic groups, according to a new study.
Investigators examined national Minimum Data Set assessment data involving the use of four psychotropic medication classes among long-stay nursing home residents with dementia from 2011 to 2017.
They looked for differences in implementation of the reduction initiatives, using timepoints for the National Partnership to Improve Dementia Care in Nursing Homes, initiated in 2012, and a change to the Five-Star ratings to include facility antipsychotic prescribing use, made in 2015.
At first, antipsychotic and sedative exposure was highest for Hispanic residents and antidepressant and anxiolytic exposure was highest for non-Hispanic white residents. Non-Hispanic Black residents, meanwhile, had the lowest exposure to each psychotropic drug class.
Antipsychotics exposure falls
Antipsychotic drug exposure then dropped for non-Hispanic whites at the time of the 2012 partnership and continued to fall afterward. In comparison, there was no significant difference in these changes for non-Hispanic Black or Hispanic residents, lead author Theresa I. Shireman, PhD, of Brown University reported.
The Five-Star rating change did not affect the level of antipsychotic use overall, they further reported, although there appeared to be some evidence of a slowed rate of decline for exposure in non-Hispanic whites.
Changes for other psychotropic classes
Shireman and colleagues found only a few significant trend differences for the other psychotropic drug classes in the racial and ethnic subgroups. Antidepressant use fell at a faster rate for non-Hispanic Black residents post-partnership. In addition, antidepressant use dropped faster among non-Hispanic Black residents and Hispanic residents than non-Hispanic whites after the Five-Star rating change. And sedative use appeared to decline faster among Hispanic residents during the post-partnership period and after the Five-Star rating change.
The study was published in JAMDA.
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