View Item 

Show simple item record

Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications
dc.contributor.authorCandon, Molly
dc.contributor.authorStrominger, Julie
dc.contributor.authorGerlach, Lauren B.
dc.contributor.authorMaust, Donovan T.
dc.date.accessioned2023-02-01T18:59:38Z
dc.date.available2024-02-01 13:59:36en
dc.date.available2023-02-01T18:59:38Z
dc.date.issued2023-01
dc.identifier.citationCandon, Molly; Strominger, Julie; Gerlach, Lauren B.; Maust, Donovan T. (2023). "Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications." Journal of the American Geriatrics Society 71(1): 89-97.
dc.identifier.issn0002-8614
dc.identifier.issn1532-5415
dc.identifier.urihttps://hdl.handle.net/2027.42/175795
dc.description.abstractBackgroundAntiepileptics are commonly prescribed to nursing home residents with Alzheimer’s disease and related dementias (ADRD) but there is little scientific support for their use in this population. It is unclear whether different antiepileptics are targeting different indications.MethodsUsing the Minimum Data Set and Medicare data, including Part D pharmacy claims, we constructed annual cohorts of residents with ADRD with long-term stays in nursing homes from 2015 to 2019. For each year, we measured the proportion of residents with ADRD in nursing homes nationwide with at least one antiepileptic prescription. We also measured trends in valproic acid, gabapentin, antipsychotic, and opioid prescribing. Finally, we examined how prescribing rates differed based on whether residents with ADRD had disruptive behaviors or reported pain.ResultsOur study sample includes 973,074 persons living with ADRD who had a long-term stay in a nursing home, which was defined as at least 3 months. The proportion of residents with ADRD with at least one antiepileptic prescription increased from 29.5% in 2015 to 31.3% in 2019, which was driven by increases in the rate of valproic acid and gabapentin prescribing. Conversely, antipsychotic prescribing rates declined from 32.1% to 27.9% and opioid prescribing rates declined from 39.8% to 31.7%. The risk of valproic acid prescribing was 10.9 percentage points higher among residents with ADRD with disruptive behaviors, while the risk of being prescribed gabapentin was 13.9 percentage points higher among residents with ADRD reporting pain.ConclusionsAntiepileptic prescribing among nursing home residents with ADRD is increasing, while antipsychotic and opioid prescribing is declining. Examining antiepileptic prescribing to residents with ADRD who had disruptive behaviors and/or reported pain suggests that two of the most common antiepileptics, valproic acid and gabapentin, are being used in clinically distinct ways. Antiepileptic prescribing of questionable risk–benefit for dementia care warrants further scrutiny.See related editorial by Carnahan et al. in this issue.
dc.publisherJohn Wiley & Sons, Inc.
dc.subject.othernursing homes
dc.subject.otherantipsychotics
dc.subject.otherantiepileptics
dc.subject.otheropioids
dc.subject.otherdementia
dc.titleAntiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications
dc.typeArticle
dc.rights.robotsIndexNoFollow
dc.subject.hlbsecondlevelGeriatrics
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Reviewed
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/175795/1/jgs18119.pdf
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/175795/2/jgs18119-sup-0001-TableS1.pdf
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/175795/3/jgs18119_am.pdf
dc.identifier.doi10.1111/jgs.18119
dc.identifier.sourceJournal of the American Geriatrics Society
dc.identifier.citedreferenceKales HC, Gitlin LN, Lyketsos CG, the Detroit Expert Panel on the Assessment and Management of the Neuropsychiatric Symptoms of Dementia. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc. 2014; 62 (4): 762 - 769.
dc.identifier.citedreferenceSoumerai SB, Ross-Degnan D, Fortess EE, Abelson J. A critical analysis of studies of state drug reimbursement policies: research in need of discipline. Milbank Q. 1993; 71: 217 - 252.
dc.identifier.citedreferenceGerlach LB, Kales HC, Kim HM, et al. Trends in antipsychotic and mood stabilizer prescribing in long-term Care in the U.S.: 2011–2014. J Am Med Dir Assoc. 2020; 21 ( 11 ): 1629 - 1635.e8.
dc.identifier.citedreferenceMaust DT, Kim HM, Chiang C, Kales HC. Association of the Centers for Medicare & Medicaid Services’ national partnership to improve dementia care with the use of antipsychotics and other psychotropics in long-term Care in the United States from 2009 to 2014. JAMA Intern Med. 2018; 178 ( 5 ): 640 - 647.
dc.identifier.citedreferenceOlivieri-Mui BL, Devlin JW, Ochoa A, Schenck D, Briesacher B. Perceptions vs. evidence: therapeutic substitutes for antipsychotics in patients with dementia in long-term care. Aging Ment Health. 2018; 22(4): 544 - 549.
dc.identifier.citedreferenceGerlach LB, Kales HC. Pharmacologic management of neuropsychiatric symptoms of dementia. Curr Treat Options Psychiatry. 2020; 7 ( 4 ): 489 - 507.
dc.identifier.citedreferenceKales HC, Valenstein M, Kim HM, et al. Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. AJP. 2007; 164 ( 10 ): 1568 - 1576.
dc.identifier.citedreferenceSupasitthumrong T, Bolea-Alamanac BM, Asmer S, Woo VL, Abdool PS, Davies SJC. Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report. Br J Clin Pharmacol. 2019; 85 ( 4 ): 690 - 703.
dc.identifier.citedreferenceJohansen ME. Gabapentinoid use in the United States 2002 through 2015. JAMA Intern Med. 2018; 178: 292 - 294.
dc.identifier.citedreferenceGoodman CW, Brett AS. Gabapentin and pregabalin for pain—is increased prescribing a cause for concern? N Engl J Med. 2017; 377: 411 - 414.
dc.identifier.citedreferenceCenters for Disease Control and Prevention. U.S. Opioid Dispensing Rate Maps: IQVIA Xponent 2006–2020. Accessed June 10, 2022. https://www.cdc.gov/drugoverdose/rxrate-maps/index.html
dc.identifier.citedreferenceMcCreedy E, Ogarek JA, Thomas KS, Mor V. The Minimum Data Set agitated and reactive behavior scale: measuring behaviors in nursing home residents with dementia. J Am Dir Assoc. 2019; 20: 1548 - 1552.
dc.identifier.citedreferenceFashaw S, Chisholm L, Mor V, et al. Inappropriate antipsychotic use: the impact of nursing home socioeconomic and racial composition. J Am Geriatr Soc. 2020; 68 (3): 630 - 636.
dc.identifier.citedreferenceUS Food and Drug Administration. FDA Warns About Serious Breathing Problems with Seizure and Nerve Pain Medicines Gabapentin (Neurontin, Gralise, Horizant) and Pregabalin (Lyrica, Lyrica CR). Published December 19, 2019. Accessed January 31, 2022. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin
dc.identifier.citedreferenceTariot PN, Schneider LS, Cummings J, et al. Chronic divalproex sodium to attenuate agitation and clinical progression of Alzheimer disease. Arch Gen Psychiatry. 2011; 68: 853 - 861.
dc.identifier.citedreferenceBaillon SF, Narayana U, Luxenberg JS, Clifton AV. Valproate preparations for agitation in dementia. Cochrane Database Syst Rev. 2018; 10: CD003945.
dc.identifier.citedreferenceMalec M, Weiner DK, Shega JW. Optimal pharmacologic pain management in the older adult: an ongoing quagmire. Pain Med. 2015;16(2): 217 - 218.
dc.identifier.citedreferencePeckham AM, Ananickal MJ, Sclar DA. Gabapentin use, abuse, and the US opioid epidemic: the case for reclassification as a controlled substance and the need for pharmacovigilance. Risk Manag Healthc Policy. 2018; 11: 109 - 116.
dc.identifier.citedreferenceHarris DA, Maclagan LC, Iaboni A, et al. Potential unintended consequences of antipsychotic reduction in Ontario nursing homes. JAMDA. 2022; 23 ( 6 ): 1066 - 1072.e7.
dc.identifier.citedreferenceMbrah AK, Nunes AP, Hume AL, et al. Prevalence and treatment of neuropathic pain diagnoses among U.S. nursing home residents. Pain. 2022; 163 ( 7 ): 1370 - 1377.
dc.identifier.citedreferenceWong JJ, Côté P, Tricco AC, Watson T, Rosella LC. Assessing the validity of health administrative data compared to population health survey data for the measurement of low back pain. Pain. 2021; 162 ( 1 ): 219 - 226.
dc.identifier.citedreferenceLacasse A, Ware MA, Dorais M, Lanctôt H, Choinière M. Is the Quebec provincial administrative database a valid source for research on chronic non-cancer pain? Pharmacoepidemiol Drug Saf. 2015; 24 ( 9 ): 980 - 990.
dc.identifier.citedreferenceLacasse A, Cauvier Charest E, Dault R, et al. Validity of algorithms for identification of individuals suffering from chronic noncancer pain in administrative databases: a systematic review. Pain Med. 2020; 21 ( 9 ): 1825 - 1839.
dc.identifier.citedreferencePeckham AM, Evoy KE, Ochs L, Covvey JR. Gabapentin for off-label use: evidence-based or cause for concern? Subst Abuse. 2018; 23 ( 12 ): 1178221818801311.
dc.identifier.citedreferenceGoodman CW, Brett AS. A clinical overview of off-label use of gabapentinoid drugs. JAMA Intern Med. 2019; 179 ( 5 ): 695 - 701.
dc.identifier.citedreferenceMack A. Examination of the evidence for off-label use of gabapentin. J Manag Care Pharm. 2003; 9 ( 6 ): 559 - 568.
dc.identifier.citedreferenceMaust DT, Strominger J, Bynum JPW, et al. Prevalence of psychotropic and opioid prescription fills among community-dwelling older adults with dementia in the US. Jama. 2020; 324: 706 - 708.
dc.identifier.citedreferenceWetzels RB, Zuidema SU, de Jonghe JF, Verhey FR, Koopmans RT. Prescribing pattern of psychotropic drugs in nursing home residents with dementia. Int Psychogeriatr. 2011; 23 ( 8 ): 1249 - 1259.
dc.identifier.citedreferenceVasudev A, Shariff SZ, Liu K, et al. Trends in psychotropic dispensing among older adults with dementia living in long-term care facilities: 2004–2013. Am J Geriatr Psychiatry. 2014; 23 ( 12 ): 1259 - 1269.
dc.identifier.citedreferenceCioltan H, Alshehri S, Howe C, et al. Variation in use of antipsychotic medications in nursing homes in the United States: a systematic review. BMC Geriatr. 2017; 17 ( 1 ): 32.
dc.identifier.citedreferenceDorsey ER, Rabbani A, Gallagher SA, Conti RM, Alexander GC. Impact of FDA black box advisory on antipsychotic medication use. Arch Intern Med. 2010; 170 ( 1 ): 96 - 103.
dc.identifier.citedreferenceLucas JA, Bowblis JR. CMS strategies to reduce antipsychotic drug use In nursing home patients with dementia show some progress. Health Aff (Millwood). 2017; 36 ( 7 ): 1299 - 1308.
dc.identifier.citedreferenceCrystal S, Jarrín OF, Rosenthal M, Hermida R, Angell B. National Partnership to Improve Dementia Care in Nursing Homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes. Innov Aging. 2020; 4 ( 3 ): igaa018.
dc.identifier.citedreferenceCMS Quality Measure, Based on MDS 3.0 Data. For more information, see the MDS 3.0 Quality Measures Users Manual.
dc.working.doiNOen
dc.owningcollnameInterdisciplinary and Peer-Reviewed


Files in this item

Name:
jgs18119.pdf
Size:
839.7KB
Format:
PDF
View/Open
Name:
jgs18119-sup-0001-TableS1.pdf
Size:
124.0KB
Format:
PDF
View/Open
Name:
jgs18119_am.pdf
Size:
483.5KB
Format:
PDF
View/Open

Show simple item record

Remediation of Harmful Language

The University of Michigan Library aims to describe its collections in a way that respects the people and communities who create, use, and are represented in them. We encourage you to Contact Us anonymously if you encounter harmful or problematic language in catalog records or finding aids. More information about our policies and practices is available at Remediation of Harmful Language.

Accessibility

If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.