Navigate Up
UPMC/University of Pittsburgh Schools of the Health Sciences
For Journalists
Managers
Telephone: 412-647-9975
Director
Telephone: 412-586-9777
Other Inquiries

Off-Label Antipsychotic Use Common in VA Nursing Home Residents, Pitt Study Finds

PITTSBURGH, Nov. 1, 2012 – More than one in four older veterans residing in U.S. Department of Veterans Affairs (VA) Community Living Centers received antipsychotic medications, and more than 40 percent of those veterans had no documented evidence-based reason for use, according to new research from the University of Pittsburgh and VA Pittsburgh Medical Center.
 
The study, the first to address this topic in VA nursing homes, finds similar rates of antipsychotic use as studies in non-VA nursing homes. The findings will be published in the November issue of the journal Medical Care and currently are available online. 
 
“Our study adds to the growing evidence base that antipsychotics have been overused in nursing homes, and the VA is not immune to this problem,” said lead author Walid Gellad, M.D., M.P.H., an assistant professor in Pitt’s School of Medicine and the Graduate School of Public Health’s Department of Health Policy and Management. “Behavioral symptoms in dementia patients are difficult to treat, and, in most cases, nursing home staff are doing what they can to keep patients comfortable and safe. We have to find better ways to do this, though.”
 
Antipsychotics have limited efficacy in alleviating behavioral problems in dementia patients, and several studies associate their use with an increased risk of mortality.
 
“The VA already is undertaking several initiatives to address the use of antipsychotics in VA nursing homes, including increasing the availability and integration of psychologist services and piloting behavioral modification programs, such as the Staff Training in Assisted Living Residences in VA (STAR-VA) program,” said Dr. Gellad, also a core faculty member with the VA Center for Health Equity Research and Promotion and a primary care physician in the VA Pittsburgh Healthcare System.
 
Dr. Gellad and his colleagues collected data on all veterans age 65 and older who were admitted for 90 or more days to one of the 133 VA Community Living Centers between January 2004 and June 2005, the most recent years for which data could be collected for this study.
 
Of the resulting 3,692 veterans, 948 – or 25.7 percent – received an antipsychotic. Among that group, 59.3 percent had an evidenced-based reason for use. The U.S. Food and Drug Administration (FDA) has approved antipsychotics for use in treating psychiatric diagnoses, such as schizophrenia, bipolar disorder and Tourette syndrome.
 
Veterans residing in Alzheimer’s or dementia special care units had 66 percent greater odds of receiving an antipsychotic, and residents with aggressive behavior had nearly three times greater odds of receiving an antipsychotic medication. Among those residents with dementia, veterans with no evidence of psychosis for which an antipsychotic would be appropriate were just as likely to receive an antipsychotic as those with documented psychosis.
 
“We couldn’t determine if clinicians are using antipsychotics in residents with dementia without considering the risks, or whether they are considering the risks but have determined that the behavioral symptoms are sufficiently problematic that the potential benefits outweigh the risks of therapy,” Dr. Gellad said. “The VA is supporting efforts for better documentation in patients’ medical records of the risk vs. benefit discussions regarding the use of these antipsychotics.”
 
Residents receiving multiple medications of any type, particularly those receiving antidepressants, were more likely to receive antipsychotics.
 
The FDA issued a warning in 2005 for the atypical antipsychotics, emphasizing their association with increased mortality when used for behavioral disorders in elderly residents with dementia. The warning was extended to all antipsychotics in 2008.
 
“Our data was collected prior to these warnings, so we cannot draw conclusions about whether they make a difference in current practices,” said Dr. Gellad. “However, despite the lack of an FDA warning at the time that the data for our study was collected, reports had already appeared in print about the risks of these drugs.”
 
Co-authors include Sherrie L. Aspinall, Pharm.D.; Steven M. Handler, M.D., Ph.D.; Roslyn A. Stone, Ph.D.; Nicholas Castle, Ph.D.; Todd P. Semla, Pharm.D.; Chester B. Good, M.D.; Michael J. Fine, M.D.; Maurice Dysken, M.D.; and Joseph T. Hanlon, Pharm.D.
 
The researchers were supported by a VA Career Development Award CDA 09-207; National Institute of Aging grants P30AG024827, T32 AG021885, K07AG033174, R01AG034056, R56AG027017 and 3U01 AG012553; National Institute of Mental Health grant R34 MH082682; National Institute of Nursing Research grant R01 NR010135; and Agency for Healthcare Research and Quality grants R01 HS017695, R01 HS018721 and K12 HS019461.

©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com