Cognition-Enhancing, Antipsychotic, and Opioid Medication Use Among Assisted Living and Residential Care Residents in Oregon

Abstract

Objectives: Explore community- and resident-level characteristics associated with polypharmacy and use of cognition-enhancing, antipsychotic, and opioid medications among a statewide representative sample of assisted living and residential care (AL/RC) residents.

Design: Cross-sectional, descriptive.

Setting and participants: A total of 1135 AL/RC residents living in 387 licensed communities in Oregon were recruited. One-third of residents lived in communities certified to provide memory care to residents with dementia.

Methods: All licensed AL/RC communities received a mail survey with questions about 3 randomly selected residents' demographic, health service use, health conditions, medication use, and payment information. We estimated bivariate and multiple logistic regression models, resulting in unadjusted and adjusted odds ratios of resident- and community-level characteristics associated with each medication use indicator.

Results: One in 5 residents took a cognition-enhancing medication (20%) in the prior 7 days. Just more than one-fifth (22%) and one-quarter (25%) of residents took opioid or antipsychotic medications, on a scheduled or as-needed basis in the prior 7 days, respectively. Residents with Alzheimer's disease or related dementia (ADRD) living in rural communities were half as likely to take cognitive-enhancing medications compared with their urban counterparts. When controlling for all resident and community covariates, residents with ADRD were almost 3 times as likely to receive an antipsychotic and half as likely to receive an opioid compared to residents without an ADRD diagnosis.

Conclusions and implications: Understanding variation in the use of medications associated with behavioral expressions of ADRD in AL/RC residents is a crucial clinical and policy area.

Keywords: Assisted living; antipsychotic; dementia treatment; medication use; opioid.