Antipsychotic and anti-anxiety prescribing in nursing home facilities can have an effect on prescribing in local and affiliated assisted living communities, a new study has found. The results suggest that assisted living should be included in efforts to reduce inappropriate prescribing, investigators say.

The researchers examined potentially inappropriate prescribing patterns in 250 assisted living communities and more than 3,000 nursing home facilities. They calculated the percentage of residents receiving antipsychotics and anti-anxiety medications and then estimated the relationship between prescribing patterns in individual assisted living communities and that of the closest and farthest five nursing homes in the state.

Among the key findings:

  1. Rates of antipsychotic and anti-anxiety prescribing in assisted living vary by state, with Texas having the highest rates for each drug class and Louisiana the lowest. 
  2. Potentially inappropriate antipsychotic prescribing in assisted living is not associated with local nursing home prescribing patterns, but anti-anxiety/hypnotic medication use is positively associated with local nursing home prescribing rates. 
  3. Antipsychotic prescribing rates are lower among assisted living communities affiliated with a nursing home, but the same relationship does not exist for anti-anxiety prescribing.

The lower inappropriate antipsychotic prescribing rates in assisted living communities affiliated with a nursing home may reflect a spillover effect within chain operations from federal efforts to reduce prescribing, Sheryl Zimmerman Ph.D., of the University of North Carolina at Chapel Hill, and colleagues proposed.

In contrast, the positive association of anti-anxiety and/or hypnotic medication prescribing rates in assisted living communities with rates in nearby nursing homes may be related to the absence of federal efforts to reduce the use of these drugs. These cases may reveal a strong overall impact on local practice patterns and behaviors, the authors wrote. 

“Taken together, these results suggest efforts to reduce off-label psychotropic medication use in nursing homes may be adapted and used to change prescribing patterns in assisted living,” the researchers concluded.

The study was published in JAMDA.