This work was supported by National Health Research and Development Program/Canadian Institutes of Health Research (CIHR) Operating Grant 660606–2000 and the CIHR Chronic Disease New Emerging Team program (NET-54010). The NET program receives joint sponsorship from the Canadian Diabetes Association, the Kidney Foundation of Canada, the Heart and Stroke Foundation of Canada, and the CIHR Institutes of Nutrition, Metabolism and Diabetes and Circulatory and Respiratory Health. Dr. Bronskill was supported in part by a New Investigator Award through the NET program. Dr. Rochon was supported in part by a CIHR Investigator Award.
Neuroleptic Drug Therapy in Older Adults Newly Admitted to Nursing Homes: Incidence, Dose, and Specialist Contact
Version of Record online: 14 APR 2004
Journal of the American Geriatrics Society
Volume 52, Issue 5, pages 749–755, May 2004
How to Cite
Bronskill, S. E., Anderson, G. M., Sykora, K., Wodchis, W. P., Gill, S., Shulman, K. I. and Rochon, P. A. (2004), Neuroleptic Drug Therapy in Older Adults Newly Admitted to Nursing Homes: Incidence, Dose, and Specialist Contact. Journal of the American Geriatrics Society, 52: 749–755. doi: 10.1111/j.1532-5415.2004.52212.x
- Issue online: 14 APR 2004
- Version of Record online: 14 APR 2004
- nursing homes;
- neuroleptic drug therapy;
- quality of care;
Objectives: To describe the incidence and dose of neuroleptic drug therapy newly dispensed for behavioral disorders to older adults admitted to nursing homes and to determine whether this use is associated with patient characteristics and contact with specialists.
Design: A retrospective cohort study using administrative data from a comprehensive and universal drug program.
Setting: All licensed nursing homes in Ontario, Canada.
Participants: All 19,780 adults aged 66 and older who had no evidence of neuroleptic drug use in the previous year and no history of major psychosis and were newly admitted to a nursing home between April 1, 1998, and March 31, 2000.
Measurements: Exposure to neuroleptic drug therapy and initial dose were measured using claims submitted to the Ontario Drug Benefit Program.
Results: A prescription for a neuroleptic therapy was dispensed to 17% of older adults with no previous neuroleptic exposure within 100 days and to 24% within 1 year of their nursing home admission. New exposure to a neuroleptic therapy was less likely in women (odds ratio (OR)=0.7, 95% confidence interval (CI)=0.6–0.8) and more likely in residents with dementia (OR=3.5, 95% CI=3.2–3.8). Almost 10% of nursing home residents received an initial dose that exceeded recommended thresholds. Only 14% of those newly exposed had prior contact with a geriatrician or psychiatrist.
Conclusion: Incident use of neuroleptics in Ontario nursing homes is substantial. Use of high doses suggests that some physicians may need better information about using these agents, particularly given the rapid adoption of atypical neuroleptic drug therapies.