Pro Re Nata Prescribing and Administration of Psychotropic Medications in Assisted Living: A 7-State Study

2021 ◽  
Author(s):  
Paula Carder ◽  
Sheryl Zimmerman ◽  
Christopher J. Wretman ◽  
John S. Preisser ◽  
Sarah Dys ◽  
...  
Keyword(s):  
Assisted Living ◽  
Psychotropic Medications ◽  
State Study ◽  
Pro Re Nata

scholarly journals Psychoactive Prescribing in Assisted Living

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 705-706
Author(s):  
Sheryl Zimmerman ◽  
Philip Sloane
Keyword(s):  
Adverse Events ◽  
Assisted Living ◽  
Prescribing Patterns ◽  
Future Research ◽  
Community Characteristics ◽  
Severe Dementia ◽  
Serious Adverse Events ◽  
Antipsychotic Medications ◽  
State Study ◽  
Pro Re Nata

Abstract More than 800,000 older adults reside in almost 30,000 assisted living (AL) communities across the country, 42% of who have moderate or severe dementia. As many as 97% of persons with dementia display symptoms of distress such as agitation or anxiety, and 69% of AL communities provide medications to treat this distress. Unfortunately, the psychoactive medications that are prescribed are often ineffective, contraindicated, and may cause serious adverse events including mortality. Especially concerning is the use of antipsychotic medications, which carry a black-box warning for persons with dementia. This symposium will present data from a seven state study of 250 AL communities and the 13,600 individuals who reside there. The first speaker will discuss the prevalence of psychoactive prescribing in AL overall and by medication type, and community characteristics that relate to use (e.g., staffing, resident case-mix). The second presentation will focus on the use of pro re nata (PRN) psychotropic medications, to examine the extent to which use is situational. The third speaker will address the use of off-label antipsychotic medications, and typologies of AL communities that differentiate use. The fourth speaker will discuss the prevalence of potential antipsychotic side-effects and adverse events, and also family member knowledge of medication use. The final speaker will compare the use of antipsychotic and antianxiety prescribing in proximate AL communities and nursing homes, to examine the extent to which local prescribing patterns may influence use. All five presentations of this symposium convey important issues for practice, policy, and future research.

scholarly journals Pro Re Nata Use of Psychotropic Medications in Assisted Living

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 706-706
Author(s):  
Paula Carder ◽  
Sheryl Zimmerman ◽  
Christopher Wretman ◽  
Sarah Dys ◽  
Philip Sloane
Keyword(s):  
Psychotropic Medication ◽  
Assisted Living ◽  
Medication Administration ◽  
Psychotropic Medications ◽  
Data Sources ◽  
Regulatory Requirements ◽  
Dementia Diagnosis ◽  
Pro Re Nata ◽  
Hospice Use ◽  
Record Review

Abstract This study examined the use of pro re nata (PRN, or as needed) psychotropic medications among assisted living (AL) residents. We examined prescriptions and administrations, and compared use based on dementia diagnosis. Data sources included interviews with administrators of 250 AL communities in 7 states and medication administration record review for the prior 7 days; analyses were weighted to the entire state. The percent of all residents prescribed a PRN psychotropic medication was 10.3%. However, residents with a dementia diagnosis were twice as likely to have a PRN psychotropic prescription (15.2% versus 7.2%; p<.001). The majority of psychotropic medications prescribed and administered were for anxiolytics/hypnotics rather than antipsychotics. Additional resident-level factors significantly associated with higher PRN prescribing included psychiatric diagnosis, incontinence, hospice use, confusion/disorientation, and agitation. We summarize these and other findings in the context of state regulatory requirements for staffing, chemical restraints, and dementia care.

Depression in Assisted Living: Results From a Four-State Study

2003 ◽  
Vol 11 (5) ◽  
pp. 534-542 ◽  
Author(s):  
Lea C. Watson ◽  
Joanne M. Garrett ◽  
Philip D. Sloane ◽  
Ann L. Gruber-Baldini ◽  
Sheryl Zimmerman
Keyword(s):  
Assisted Living ◽  
State Study

scholarly journals An Empirical Typology of Residential Care/Assisted Living Based on a Four-State Study

2006 ◽  
Vol 46 (2) ◽  
pp. 238-248 ◽  
Author(s):  
N. S. Park ◽  
S. Zimmerman ◽  
P. D. Sloane ◽  
A. L. Gruber-Baldini ◽  
J. K. Eckert
Keyword(s):  
Residential Care ◽  
Assisted Living ◽  
Empirical Typology ◽  
State Study

scholarly journals Effects of Antipsychotic Medication on Mortality in Long-Term Care Home Residents

2020 ◽  
Author(s):  
Michael John Stones ◽  
Jason Randle ◽  
Peter Brink
Keyword(s):  
Antipsychotic Medication ◽  
High Mortality ◽  
Long Term Care ◽  
Care Home ◽  
Psychotropic Medications ◽  
Initial Assessment ◽  
Mortality Data ◽  
Term Care ◽  
Pro Re Nata

This chapter examines mortality in long-term care home (LTCH) residents as associated with the use antipsychotic medication when combined with other psychotropic medications. The data at census-level pertain to all new admissions to long-term care homes (LTCH) in Ontario, Canada, during a given financial year (i.e., over 20,000 LTCH residents). The observations include comprehensive assessment upon admission and at quarterly intervals thereafter for a maximal period of 1-year after the initial assessment. The mortality data derive from three linked databases, with mortality classified as death within 90 days of the final assessment. The findings indicate that combinations of concurrent daily usage of antipsychotic medication with daily usage of other psychotropic medications (particularly antidepressants and analgesics) are associated with relatively low mortality, whereas intermittent usage (e.g. pro re nata; as needed) is associated with relatively high mortality.

scholarly journals Assisted Living Care for Special Populations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 676-676
Author(s):  
Philip Sloane ◽  
Sheryl Zimmerman
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Assisted Living ◽  
Sleep Disturbances ◽  
Future Research ◽  
Care Needs ◽  
Term Care ◽  
State Study ◽  
Hospice Use

Abstract Assisted living (AL) is a notable provider of residential long-term care for older adults; there are almost twice as many AL communities as nursing homes, and they provide care to more than 800,000 older adults. As AL has evolved, it has come to serve more individuals with cognitive, mental, and health care needs. For example, 70% of residents have sleep disturbances, 42% have moderate/severe dementia, and mortality rates average 14% annually. Care needs include those for behaviors such as agitation, serious mental illness, and at the end-of-life. However, not all AL communities provide similar care. This symposium will use national data and data from a seven state study of 250 AL communities to focus on four populations receiving care in AL: persons with dementia, serious mental illness, sleep disturbances, and on hospice. The first speaker will discuss how AL staff conceive of and respond to behavioral expressions of persons with dementia; the second will focus on the use of psychosocial/environmental practices for persons with dementia in AL. The third speaker will discuss the growing proportion of persons with serious mental illness in AL and related implications for care. The fourth presenter will address the high use of melatonin in AL, as well as resident- and community-level correlates of melatonin prescribing. The final speaker will examine hospice use in AL and how it varies based on community characteristics. These findings related to care and care needs for four key populations have important implications for practice, policy, and future research.

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