Shekinah A. Fashaw-Walters, Ph.D.; Image credit: University of Minnesota
Shekinah Fashaw-Walters, Ph.D.; Image credit: University of Minnesota

More schizophrenia diagnoses were recorded for Black U.S. nursing home residents with dementia after the launch of a federal initiative to reduce antipsychotic use in these settings, a new study has found.

It is known that schizophrenia diagnoses have risen in nursing homes since the Centers for Medicare & Medicaid Services established its National Partnership to Improve Dementia Care in 2012. In the current study, investigators aimed to examine how race and Alzheimer’s and related dementias (ADRD) might be linked to these rising rates.

Investigators looked at the prevalence of schizophrenia among long-stay residents aged 65 years and older by Black race and ADRD status, using 2011 to 2015 MDS 3.0 assessments. Results were controlled for age, sex, function and frailty measures, and behavioral expressions.

Among more than 1.2 million older long-stay residents annually, schizophrenia diagnoses were highest among residents with ADRD, the study team found. And prior to the CMS partnership, Black residents without ADRD had higher rates of schizophrenia diagnoses compared to their nonblack counterparts, reported Shekinah A. Fashaw-Walters Ph.D., of the University of Minnesota and Brown University. 

After the CMS partnership launched, the rate of schizophrenia diagnoses for Black residents with ADRD jumped by 1.7% — a statistically significant increase that occurred among these residents only, Fashaw-Walters and colleagues found.

Results suggest unintended consequences

Racial and ethnic disparities in nursing home care quality have been well documented, and the study results suggest that regulatory initiatives may have unintended consequences for the most vulnerable nursing home residents, the authors wrote.

In fact, initial reports of the CMS partnership’s impact suggest that nursing homes were increasingly reporting schizophrenia diagnoses among residents “potentially as a means to skirt the intent of the initiative (curtail antipsychotic use) and allow nursing home staff to manage ‘challenging’ behaviors with antipsychotic medications under the guise of schizophrenia,” they noted.

The current results align with those of past studies, in part, “and suggest that either schizophrenia prevalence was increasing in the nursing home or providers were increasing their documentation of schizophrenia but disproportionately for Black nursing home residents with ADRD as compared to all other nursing home residents,” Fashaw-Walters and colleagues wrote.

“Further work is needed to examine the impact of ‘colorblind’ policies such as the partnership and to determine if schizophrenia diagnoses are appropriately applied in nursing home practice, particularly for Black Americans with ADRD,” they concluded.

Full findings were published in the Journal of the American Geriatrics Society.

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Nursing homes, feds hide sky-high antipsychotic use with dubious diagnoses: report At least one-fifth of nursing home residents are taking the drugs, many for schizophrenia, a diagnosis that has skyrocketed in these settings since 2012, investigators have found.