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Dys S, Tunalilar O, Carder P. Prevalence and Correlates of Antipsychotic Medication Use in Oregon Assisted Living. J Am Med Dir Assoc 2024; 25:105073. [PMID: 38857687 DOI: 10.1016/j.jamda.2024.105073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/05/2024] [Accepted: 05/06/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Investigate how assisted living and residential care (AL/RC) and memory care (MC) contexts are associated with the 90-day prevalence of antipsychotic medication use (APU), considered a quality measure in long-term care. DESIGN All licensed AL/RC settings in Oregon received an annual mailed questionnaire to provide aggregate resident demographics, health acuity, health service use, payment type, and organizational policies. Organizational measures were collected from state websites. METHODS Random intercepts regression models were estimated to assess organizational and resident population characteristics associated with 90-day APU prevalence over 3 study waves (2017-2019). SETTING AND PARTICIPANTS We examine 932 observations in 463 AL/RC settings from 2017 to 2019 (137 settings participated in all 3 waves, 195 in 2 waves, and 131 in 1 wave). RESULTS The average 90-day APU prevalence in 464 Oregon AL/RC settings is 30.7%, although rates differ by MC endorsement (23.9% in AL/RC and 42.7% in MC). Nonprofit settings were associated with lower rates of APU in both AL/RC [β = -4.4 (percentage points), 95% CI -8.4, -0.4] and MC (β = -12.4, 95% CI -21.2, -3.6). Compared with low-Medicaid settings, settings with very high proportions of Medicaid residents were associated with higher APU prevalence, +8.9 in AL/RC (95% CI 1.7, 16.1) and +11.0 percentage points in MC (95% CI 2.3, 19.8). CONCLUSIONS AND IMPLICATIONS APU prevalence in MC settings and with high-Medicaid populations is considerably higher than non-MC and lower-Medicaid settings. Federal policies guide APU in nursing homes but not AL/RC. No national database of AL/RC exists; thus, state-based studies can inform the discussion of state policy and practice development. Additional study is needed to contextualize the relationships between AL/RC population-level practices and characteristics and the APU prevalence to inform policy and practice development related to this measure as a quality indicator.
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Affiliation(s)
- Sarah Dys
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, USA.
| | - Ozcan Tunalilar
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, USA; Nohad A. Toulan School of Urban Studies and Planning, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - Paula Carder
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, USA; School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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Dys S, Carder P. Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living. J Appl Gerontol 2023; 42:2198-2206. [PMID: 37268438 DOI: 10.1177/07334648231181517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are primarily responsible for noncompliance, (2) unclear parameters place direct care workers in a role paradox, and (3) there is a persistent disconnect about when to seek qualified expertise before requesting psychotropic medications. AL/RC-specific mechanisms for medication prescription and administration are necessary to improve the structure and processes of care. Policymakers might consider how regulations unintentionally incentivize task-oriented versus person-centered care practices.
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Affiliation(s)
- Sarah Dys
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - Paula Carder
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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Manis DR, Katz P, Lane NE, Rochon PA, Sinha SK, Andel R, Heckman GA, Kirkwood D, Costa AP. Clinical Comorbidities and Transitions Between Care Settings Among Residents of Assisted Living Facilities: A Repeated Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1356-1360. [PMID: 37507099 DOI: 10.1016/j.jamda.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We investigate the changes in the sociodemographic characteristics, clinical comorbidities, and transitions between care settings among residents of assisted living facilities. DESIGN Repeated cross-sectional study. SETTING AND PARTICIPANTS Linked, individual-level health system administrative data on residents of assisted living facilities in Ontario, Canada, from January 1, 2013, to December 31, 2019. METHODS Counts and proportions were calculated to describe the sociodemographic characteristics and clinical comorbidities. Relative changes and trend tests were calculated to quantify the longitudinal changes in the characteristics of residents of assisted living facilities between 2013 and 2019. A Sankey plot was graphed to display transitions between different care settings (ie, hospital admission, nursing home admission, died, or remained in the assisted living facility) each year from 2013 to 2019. RESULTS There was a 34% relative increase in the resident population size of assisted living facilities (56,9752019 vs 42,6002013). These older adults had a mean age of 87 years, and women accounted for nearly two-thirds of the population across all years. The 5 clinical comorbidities that had the highest relative increases were renal disease (24.3%), other mental health conditions (16.8%), cardiac arrhythmias (9.6%), diabetes (8.5%), and cancer (6.9%). Nearly 20% of the original cohort from 2013 remained in an assisted living facility at the end of 2019, and approximately 10% of that cohort transitioned to a nursing home in any year from 2013 to 2019. CONCLUSIONS AND IMPLICATIONS Residents of assisted living facilities are an important older adult population that has progressively increased in clinical complexity within less than a decade. Clinicians and policy makers should advocate for the implementation of on-site medical care that is aligned with the needs of these older adults.
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Affiliation(s)
- Derek R Manis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | - Paul Katz
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Natasha E Lane
- ICES, Toronto, Ontario, Canada; Department of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paula A Rochon
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada; Division of Geriatric Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir K Sinha
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine and Geriatrics, Sinai Health and University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; National Institute on Ageing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada; Schlegel Research Institute for Aging, Waterloo, Ontario, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Lei L, Samus QM, Thomas KS, Maust DT. Medication Costs and Use of Older Americans in Assisted Living Settings: a Nationally Representative Cross-Sectional Study. J Gen Intern Med 2023; 38:294-301. [PMID: 35132546 PMCID: PMC9905365 DOI: 10.1007/s11606-022-07434-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Assisted-living (AL) settings are an important residential care option for old and disabled Americans, but there are no national data characterizing medication use in AL. OBJECTIVE To investigate medication costs and use of older adults living in the AL settings compared to those in the community, independent living, and nursing home settings. DESIGN 2015 National Health and Aging Trends Study; nationally representative cross-sectional study. PATICIPANTS Respondents ≥ 65 years with Medicare Part D prescription drug coverage (n = 5980, representing 32.34 million older adults). MEASURES Total Part D medication costs; number of 30-day prescription fills; binary indicators for overall polypharmacy (≥ 5 and ≥ 10 concurrent medications), prescription fills of opioid and psychotropic medications including antipsychotics, benzodiazepines, gabapentinoids, antidepressants, and central nervous system-active (CNS-active) polypharmacy. RESULTS Adjusting for demographics, the annual medication costs among AL residents, at $3890, were twice as high as those of their community-dwelling counterparts ($1932; p < .01). All medication outcomes except opioids were higher for older adults in AL compared to community settings. While the adjusted number of 30-day prescription fills among AL residents was slightly lower than that of nursing home residents (89.5 vs. 106.2; p < .05), AL residents experienced equivalent rates of overall polypharmacy ≥ 10 medications (30.2% vs. 23.5%), antipsychotics (30.8% vs. 27.8%), benzodiazepines (30.7% vs. 32.6%), gabapentinoids (21.2% vs. 16.1%), and CNS-active polypharmacy (26.0% vs. 36.9%; p > .05 for all). Patterns of use across settings were consistent when limited to older adults with dementia. CONCLUSIONS Older Americans in AL experience a prescription medication burden similar to those in nursing homes. AL settings have an important opportunity to ensure their medication-related clinical services and supports match the needs of their residents.
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Affiliation(s)
- Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kali S Thomas
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI, USA
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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