Use of physician extenders associated with increase in antidepressant prescribing in nursing homes

Research Activities, February 2011, No. 366

Depression is a common condition among elderly residents of nursing homes. Those who are depressed have an increased risk for dementia, stroke, heart disease, and even death. The prescribing of antidepressants among older nursing home residents has risen dramatically in the past decade, reveals a new study. This increase was associated with certain staffing patterns and coprescribing of other psychotropic medications. The longitudinal study looked at residents admitted to 12,556 nursing homes between 1996 and 2006. Staffing patterns were also analyzed, including the number of hours spent on site by medical directors. The use of antidepressants more than doubled from 21.9 percent in 1996 to 47.5 percent in 2006.

After controlling for a variety of factors, the researchers found that the increase in antidepressant prescribing was associated with physician extenders, nurses, and nurses' aides spending more time in the nursing homes and with residents who also received a sedative/hypnotic. However, when medical directors and physicians spent more time in the facilities, there was less likelihood of increasing antidepressant use. The prescribing of either antianxiety or antipsychotic agents also decreased the risk of increasing antidepressant use.

It's not clear whether this increase in antidepressant prescribing is appropriate, note the researchers. They call for more interventions to improve the appropriate use of antidepressants in nursing homes. The study was supported in part by the Agency for Healthcare Research and Quality (HS17695 and HS18721).

See "Antidepressant prescribing in U.S. nursing homes between 1996 and 2006 and its relationship to staffing patterns and use of other psychotropic medications," by Joseph T. Hanlon, Pharm.D., M.S., Steven M. Handler, M.D., Ph.D., and Nicholas G. Castle, Ph.D., in the June 2010 Journal of the American Medical Directors Association 11(5), pp. 320-324.

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