Associated factors with antipsychotic use in assisted living facilities: a cross-sectional study of 4367 residents.

BACKGROUND

antipsychotics are widely used in assisted living (AL facilities). Even more, the prescription of these drugs is gradually increasing since the availability of second-generation atypical antipsychotics. More knowledge is needed on prescription reasons to understand this increasing prevalence.

METHODS

cross-sectional analysis of 4,367 residents. Data were obtained from medical records assessed by geriatricians from the AL facility. A multiple logistic regression model (backward stepwise) was used to assess the independent associated factors with antipsychotic use.

RESULTS

antipsychotic prescription was found in 1,203 (27.5%) of 4,367 residents. The independent associated factors with the use of antipsychotics were the presence of a psychiatric disorder [odds ratio, OR = 5.30 (4.42-6.35)], the age under 80 years [OR = 2.08 (1.62-2.68)], admission from another institution [OR = 1.49 (1.12-1.98)], treated dementia [OR = 1.84 (1.47-2.30)], the presence of neuropsychiatric symptoms (NPS): verbal outbursts [OR = 2.58 (1.96-3.39)], threatening behaviours or physical violence [OR = 2.13 (1.71-2.65)], and aimless wandering [OR = 1.55 (1.17-2.04)], the presence of cardiovascular disease [OR = 0.79 (0.65-0.96)] and the presence of cerebrovascular disease [OR = 0.77 (0.64-0.92)].

CONCLUSIONS

the study found that more than a quarter of the residents received antipsychotics. This study also highlighted the independent associated factors with antipsychotic prescription showing 'off-label' prescriptions in conditions such as dementia and certain NPS. The study findings suggest that improvements in the management of dementia and NPS in AL facilities are needed. Non-pharmacological alternatives should be enhanced and further developed viewing the high prevalence of antipsychotic prescription.