Inappropriate Antipsychotic Use: The Impact of Nursing Home Socioeconomic and Racial Composition

Abstract

Objectives: Previous research suggests black nursing home (NH) residents are more likely to receive inappropriate antipsychotics. Our aim was to examine how NH characteristics, particularly the racial and socioeconomic composition of residents, are associated with the inappropriate use of antipsychotics.

Design: This study used a longitudinal approach to examine national data from Long-Term Care: Facts on Care in the US (LTCFocUS.org) between 2000 and 2015. We used a multivariate linear regression model with year and state fixed effects to estimate the prevalence of inappropriate antipsychotic use at the NH level.

Setting: Free-standing NHs in the United States.

Participants: The sample consisted of 12 964 NHs.

Measurements: The outcome variable was inappropriate antipsychotic use at the facility level. The primary indicator variables were whether a facility had high proportions of black residents and the percentage of residents with Medicaid as their primary payer.

Results: NHs with high and low proportions of blacks had similar rates of antipsychotic use in the unadjusted analyses. NHs with high proportions of black residents had significantly lower rates of inappropriate antipsychotic use (β = -2; P < .001) in the adjusted analyses. Facilities with high proportions of Medicaid-reliant residents had higher proportions of inappropriate use (β = .04; P < .001).

Conclusion: Findings from this study indicate a decline in the use of antipsychotics. Although findings from this study indicated facilities with higher proportions of blacks had lower inappropriate antipsychotic use, facility-level socioeconomic disparities continued to persist among NHs. Policy interventions that focus on reimbursement need to be considered to promote reductions in antipsychotic use, specifically among Medicaid-reliant NHs. J Am Geriatr Soc 68:630-636, 2020.

Keywords: medication restraint use; nursing home; quality of care; racial/ethnic disparities; socioeconomic disparities.

Figure 1.

(A, B) Predicted percentage of residents given antipsychotics inappropriately, by year, nursing home (NH) racial composition, and Medicaid reliance between 2000 and 2015 for all NHs. Note: Predicted proportion of residents inappropriately administered antipsychotics was calculated using the adjusted model (Table 2). For panel B (Medicaid reliance), another adjusted model, not shown in Table 2, was used to calcuate the predicted percentage of inappropriate antipsychotic use. Medicaid reliance is based on a binary variable (Medicaid reliant vs non-Medicaid reliant) that indicates if 85% or greater of a NH’s residents have Medicaid as their priamary payer. This measure was developed empircally. APs, antipsychotics; CMS, Centers for Medicare & Medicaid Services; FDA, Food and Drug Administration.