Psychotropic and psychoactive drugs and hospitalization rates in nursing facility residents

The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug «load» between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates. Methods: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some177 patients resident for 30 or more days over a 19 month period of 2978 patient-months data were tabulated. A monthly repeated-measures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations. Results: The rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation. Conclusion: Preliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total «load» of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility (AU)

El propósito de este estudio fue determinar si había diferencias en las tasas de hospitalización debido a la carga de agentes psicoactivos en una residencia de ancianos entre los que utilizan psicotropos con los que no o los habían usado antes; determinar si el diagnóstico de demencia y el cambio en el uso y carga de medicamentos psicotrópicos y psicoactivos influye en las tasas de hospitalización. Métodos: Se realizó un estudio observacional de una cohorte retrospectiva de historiales de pacientes, cambios de situación en la residencia e informes del farmacéutico en una residencia de ancianos avanzada de más de 100 camas. Se tabularon datos de 177 residentes de 30 días o más durante un periodo de 19 meses, tabulándose un total de 2978 pacientes-mes. Se realizó un método de medidas repetidas de cambios de situaciones clínicas, enfermedades y medicación, para determinar la demografía, el uso de medicamentos y las hospitalizaciones de cada paciente. Resultados: Las tasas de hospitalización variaron de 0,04 a 0,07 por paciente/mes para el uso de cualquier psicoactivo en los que tenían o no diagnóstico de demencia. La tasa de hospitalización durante el periodo de estudio para los que no usaban actualmente psicotropos o psicoactivos fue de 0,02 y 0,03 por paciente/mes para los que tenían diagnóstico de demencia y los que no, respectivamente, aunque el 86% de esta muestra había usado psicotropos o psicoactivos antes del periodo de observación. Conclusión: Se ofrece evidencia preliminar que sugiere que los psicotropos y psicoactivos y la carga total de estos medicamentos puede estar asociada al aumento en la tasa y el riesgo de hospitalizaciones en una residenciad e ancianos avanzada (AU)

Assessment of psychotropic and psychoactive drug loads and falls in nursing facility residents.

OBJECTIVE: To determine if there were any differences in fall risk and actual falls between those who were prescribed and those who were not prescribed psychotropic and psychoactive medications in a skilled nursing facility. DESIGN: An observational, retrospective cohort study of prospective patient data in a skilled nursing facility. SETTING: A public skilled nursing facility of more than 100 beds. PATIENTS: Patient charts and consultant pharmacists' drug regimen review monthly report records for 177 patients who were residents for 30 or more days over a 19-month period during 1996-1997 were tabulated. INTERVENTIONS: A fall risk using an assessment method that incorporated patient fall history, conditions, diseases, and medications associated with falls was performed on each resident. MAIN OUTCOME MEASURES: Patient demographics, medication usage, fall risk, and fall occurrences. RESULTS: Falls occurred in 107 of 177 (60.5%) residents over the study period. There were 428 documented falls. Fall rates appeared to be directly related to the number of psychotropic drugs, but not other psychoactive medications, until two or more were used concurrently. CONCLUSIONS: Preliminary evidence suggests multiple psychotropic and psychoactive drugs may increase the risk of falls in a skilled nursing facility in proportion to the total load of these agents. Minimization of inappropriate prescribing of psychotropic and psychoactive medications in elderly nursing facility residents, as mandated by current federal guidelines, may affect the risk of falls in nursing facility patients.

Psychotropic and psychoactive drugs and hospitalization rates in nursing facility residents.

UNLABELLED: The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug "load" between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates. METHODS: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some177 patients resident for 30 or more days over a 19 month period of 2978 patient- months data were tabulated. A monthly repeated- measures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations. RESULTS: The rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation. CONCLUSION: Preliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total "load" of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility.