The rate of potentially inappropriate prescribing of drugs in assisted living is 15% for antipsychotics and 21% for antianxiety medications, according to the authors of a new study published in JAMDA, The Journal of Post-Acute and Long-Term Care Medicine. But the increased focus on reducing the off-label use of antipsychotic drugs in nursing homes has affected affiliated assisted living communities, the researchers found.

For communities that are part of chains, how medications are used may be more a reflection of a higher degree of corporate standardization and oversight rather than physician prescribing patterns, they said.

The study authors — from Brown University; the University of North Carolina, Chapel Hill; Portland State University; and the American Health Care Association / National Center for Assisted Living — say that theirs is first-of-its-kind research that found that rates of potentially inappropriate antipsychotic use in assisted living communities were not associated with rates in the nearest and farthest-away nursing homes. In assisted living communities affiliated with nursing homes, however, a lower rate of off-label medication use was observed.

Rates of the use of antianxiety medications also were found to be significantly associated with the rates of use at neighboring nursing homes.

The authors also found that rates of antipsychotic and antianxiety prescribing in assisted living varies by state. Texas, for instance, was among the top two states in rates of prescribing both types of medications, whereas Louisiana was the lowest. 

“The variation in rates of prescribing may be a function of the underlying population in these communities or the regulations pertaining to medication administration and care of residents with dementia and mental health diagnoses,” they wrote.

Researchers looked at a random sample of 250 assisted living communities and a full sample of 3,371 nursing homes in seven states to determine the percentage of residents receiving antipsychotics and antianxiety medications.

One of the authors of the study was Lindsay Schwartz, Ph.D., of the National Center for Assisted Living, for which reducing off-label use for antipsychotics for residents with dementia is a goal of its Quality Initiative.

“AHCA / NCAL and our members have been an active partner in a national effort to reduce the unnecessary use of antipsychotic medications, and providers have made significant progress,” an AHCA / NCAL spokeswoman told McKnight’s Senior Living. “With four in 10 assisted living residents living with dementia, we must promote non-pharmacological interventions that improve their quality of life. We will continue to work with physicians, failed and other stakeholders to learn and share all that we can, so that every resident can receive the highest quality care.”

JAMDA is the official journal of AMDA–The Society for Post-Acute and Long-Term Care Medicine. The study, published in the September issue, arrives just as the New York Times published the results of an investigation that alleges that some nursing homes may be changing residents’ diagnoses from dementia to schizophrenia in order to continue prescribing antipsychotic medicine, in the process obscuring the true rate of antipsychotic drug use in such settings.