Image of Paula Carder, Ph.D.

A study in Oregon assisted living and residential care communities sheds new light on medication trends in these settings, including a notable quirk in rural care.

Investigators looked at polypharmacy and prescribing of cognition-enhancing, antipsychotic and opioid medications in residents. Among their findings:

  • Residents with Alzheimer’s disease or related dementia, or ADRD, living in rural communities were half as likely to take cognitive-enhancing medications compared with their urban counterparts. (These medications included Aricept, Exelon and Razadyne.)
  • One in five residents took a cognition-enhancing medication in the prior seven days. 
  • Just more than one-fifth (22%) and one-quarter of residents took opioid or antipsychotic medications on a scheduled or as-needed basis in the prior seven days, respectively. 
  • When controlling for all resident and community covariates, residents with ADRD were almost three times as likely to receive an antipsychotic and half as likely to receive an opioid compared with residents without an ADRD diagnosis.

Although antipsychotic medication use in long-term care has received much attention, less has been paid to other medications used in assisted living or in residential care residents with ADRD, contends Paula Carder, Ph.D., of the Oregon Health Sciences University–Portland State University, Portland, OR. 

Clinicians whose residents or patients living in memory care settings may wish to review indications for antipsychotic and opioid medications, whereas those with residents / patients in rural communities might consider whether their patients with ADRD have adequate access to cognitive enhancers, Carder and colleagues suggested.

“Medication review for all 3 medication classes is warranted based on variation by resident- and AL/RC community characteristics,” they wrote.

The study included 1,135 residents living in 387 licensed communities in Oregon. It was published as an article-in-press in JAMDA.