ArticleThe American journal of psychiatry2022
Evaluation of Antipsychotic Reduction Efforts in Patients With Dementia in Veterans Health Administration Nursing Homes.
Article in The American journal of psychiatry, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 25 citations in OpenAlex.
- Off-Label Initiation of Gabapentin and Valproic Acid Among Long-Stay Nursing Home Residents With and Without Dementia.Journal of the American Geriatrics Society · 2026Article
- Implementing antipsychotic reduction in long-term care: interdisciplinary and lived-experience insights into system-level barriers and facilitators.The Gerontologist · 2026Article
- Patterns of Daily Administration of Psychoactive Drug Classes for Distress Behavior in Dementia.Journal of the American Medical Directors Association · 2026Article
- Variation in Psychotropic and Non-Psychotropic Prescribing in Nursing Homes: A Multi-Level EMR-Based Retrospective Cohort Study.Journal of the American Geriatrics Society · 2026Article
- Barriers and facilitators to implementing strategies for reducing inappropriate antipsychotic use in long-term care: a scoping review.BMC geriatrics · 2026Article
- Deprescribing for People with Dementia: A Roadmap.Drugs & aging · 2025Review
- Effects of Nursing Home Changes in Antipsychotic Use on Outcomes among Residents with Dementia.Journal of the American Medical Directors Association · 2025Observational
- Relationship between facility number of clinicians and prescribing intensity of psychotropic medications, opioids, and antibiotics in ambulatory practice.BMC health services research · 2024Article
- Central Nervous System-Active Prescriptions in Older Veterans: Trends in Prevalence, Prescribers, and High-risk Populations.Journal of general internal medicine · 2023Article
- Federal Nursing Home Policies on Antipsychotics had Similar Impacts by Race and Ethnicity for Residents With Dementia.Journal of the American Medical Directors Association · 2023Article
- Nursing Homes Underreport Antipsychotic Use but Overreport Diagnoses Qualifying for Appropriate Use.Health affairs scholar · 2023Article
- Psychotropic medication prescribing in assisted living and nursing home residents with dementia after the National Partnership.Journal of the American Geriatrics Society · 2022Article
- Nursing Home Characteristics Associated with Antipsychotic Prescribing After Implementation of the National Antipsychotic Reduction Initiative (ARI).Clinical gerontologistArticle
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
objectiveThe Veterans Health Administration (VHA) and the Centers for Medicare and Medicaid Services (CMS) each created initiatives to reduce off-label use of antipsychotics in patients with dementia in nursing homes. Although CMS has reported antipsychotic reductions, the impact on prescribing of antipsychotic and other CNS-active medications in the VHA remains unclear. The authors evaluated national trends in antipsychotic and other CNS-active medication prescribing for nursing home patients with dementia in the VHA.
methodsThe study sample was all veterans with dementia residing in VHA nursing homes for more than 30 days (N=35,742). Using an interrupted time-series design, the quarterly prevalences of antipsychotic, antidepressant, antiepileptic, anxiolytic, opioid, and memory medication prescribing were evaluated from FY2009 through FY2018.
resultsAntipsychotic prescribing in VHA nursing homes declined from FY2009 to FY2018 (from 33.7% to 27.5%), with similar declines in anxiolytic prescribing (from 33.5% to 27.1%). During this period, prescribing of antiepileptics, antidepressants, and opioids increased significantly (antiepileptics: from 26.8% to 43.3%; antidepressants: from 56.8% to 63.4%; opioids: from 32.6% to 41.2%). Gabapentin served as the main driver of antiepileptic increases (from 11.1% to 23.5%). Increases in antidepressant prescribing included sertraline, mirtazapine, and trazodone. From FY2009 to FY2018, the overall prescribing of non-antipsychotic psychotropic medications grew from 75.0% to 81.1%.
conclusionsAntipsychotic and anxiolytic prescribing for VHA nursing home residents with dementia declined, although overall prescribing of other psychotropic and opioid medications increased. Policies focused primarily on reducing antipsychotic use without considering use in the context of other medications may contribute to growth in alternative medication classes with even less evidence of benefit and similar risks.
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