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      Psychotropic and pain medication use in nursing homes and assisted living facilities during COVID‐19

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      , PhD 1 , 2 , , , MD, MS 3 , 4 , 5 , , PharmD, MSW 6 , , PhD 3
      Journal of the American Geriatrics Society
      John Wiley & Sons, Inc.

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          Is Open Access

          Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada

          Key Points Question How are COVID-19 and related disruptions in care associated with changes in the dispensation of medications commonly used among nursing home residents? Findings In this population-based cohort study with an interrupted time-series analysis of all nursing home residents from the 630 facilities in Ontario, Canada, the emergence of the COVID-19 pandemic was associated with significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids and no meaningful changes in the use of antibiotics or selected cardiovascular medications. Meaning The finding of increased use of medications with the potential for adverse effects among nursing home residents during the initial wave of the pandemic warrants ongoing monitoring for prescribing appropriateness and related resident outcomes.
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            The quality of antipsychotic drug prescribing in nursing homes.

            The prescribing of antipsychotic drugs has been increasing in nursing homes (NHs) since the availability of second-generation antipsychotic agents, also known as the atypicals, but there is little information on the appropriateness of such prescribing. A retrospective analysis using the nationally representative data set of the Medicare Current Beneficiary Survey merged to Minimum Data Sets assessments, medication administration records, and Medicare claims. We identified a sample of 2.5 million Medicare beneficiaries in NHs during 2000-2001 (unweighted n = 1096) to assess prevalence of antipsychotic use, rates of adherence to NH prescribing guidelines, and changes in behavioral symptoms. Approximately 693 000 (unweighted n = 302), or 27.6%, of all Medicare beneficiaries in NHs received at least 1 prescription for antipsychotics during the study period: 20.3% received atypicals only; 3.7%, conventionals only; and 3.6%, both atypicals and conventionals. Less than half (41.8%) of treated residents received antipsychotic therapy in accordance with NH prescribing guidelines. One (23.4%) in 4 patients had no appropriate indication, 17.2% had daily doses exceeding recommended levels, and 17.6% had both inappropriate indications and high dosing. Patients receiving antipsychotic therapy within guidelines were no more likely to achieve stability or improvement in behavioral symptoms than were those taking antipsychotics outside the guidelines. This study detected the highest level of antipsychotic use in NHs in over a decade. Most atypicals were prescribed outside the prescribing guidelines and for doses and indications without strong clinical evidence. Failure to detect positive relationships between behavioral symptoms and antipsychotic therapy raises questions about the appropriateness of prescribing.
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              Assessment of Psychotropic Drug Prescribing Among Nursing Home Residents in Ontario, Canada, During the COVID-19 Pandemic

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                Author and article information

                Contributors
                david.stevenson@vanderbilt.edu
                Journal
                J Am Geriatr Soc
                J Am Geriatr Soc
                10.1111/(ISSN)1532-5415
                JGS
                Journal of the American Geriatrics Society
                John Wiley & Sons, Inc. (Hoboken, USA )
                0002-8614
                1532-5415
                06 March 2022
                May 2022
                06 March 2022
                : 70
                : 5 ( doiID: 10.1111/jgs.v70.5 )
                : 1345-1348
                Affiliations
                [ 1 ] Department of Health Policy Vanderbilt University School of Medicine Nashville Tennessee USA
                [ 2 ] Geriatric Research, Education, and Clinical Center (GRECC) VA Tennessee Valley Healthcare System Nashville Tennessee USA
                [ 3 ] Department of Health Care Policy Harvard Medical School Boston Massachusetts USA
                [ 4 ] Department of Psychiatry Harvard Medical School Boston Massachusetts USA
                [ 5 ] McLean Hospital Belmont Massachusetts USA
                [ 6 ] University of Maryland School of Pharmacy Baltimore Maryland USA
                Author notes
                [*] [* ] Correspondence

                David G. Stevenson, Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End, Suite #1200, Nashville, TN 37203, USA.

                Email: david.stevenson@ 123456vanderbilt.edu

                Author information
                https://orcid.org/0000-0002-3370-3277
                https://orcid.org/0000-0002-3979-1706
                Article
                JGS17739
                10.1111/jgs.17739
                9115065
                35233762
                38564023-d2ff-4aab-88d5-8eec9d3623eb
                © 2022 The American Geriatrics Society.

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 14 February 2022
                : 17 December 2021
                : 20 February 2022
                Page count
                Figures: 1, Tables: 1, Pages: 10, Words: 1988
                Categories
                Letter to the Editor
                COVID‐19‐Related Content
                Letters to the Editor
                Research
                Custom metadata
                2.0
                May 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.6 mode:remove_FC converted:18.05.2022

                Geriatric medicine
                Geriatric medicine

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