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Nursing homes are beginning to use psychotropic drugs more often for clinical reasons than for restraint of residents

There has long been a concern about the use of psychotropic (mind-altering) drugs to restrain nursing home residents simply for discipline or convenience rather than for appropriate clinical symptoms. With the passage of the 1987 Nursing Home Reform Act (NHRA), nursing homes are no longer allowed to use these medications except for justifiable clinical reasons. The Federal law seems to have had some impact, according to a recent study.

The study found that although the use of antipsychotic drugs increased a bit from 1990 to 1993 (14 percent to 17 percent), clinical factors were slightly more significant in 1993 in use of both antipsychotics and antianxiety/hypnotic drugs. This suggests that the use of psychotropic drugs is more clinically motivated than in the past, concludes Nicholas G. Castle, of AtlantiCare Health System, author of the study.

In 1990, nursing home residents who were more physically impaired, older, or had a prior stroke were significantly less likely to receive antipsychotic drugs. Those who were more cognitively impaired or suffered from dementia, depression, or a history of psychiatric problems were significantly more apt to receive antipsychotic drugs. In 1993, a largely similar pattern of effects was observed, with the addition of anxiety disorders as increasing the likelihood of receiving antipsychotic drugs. In 1993, nursing home residents with a history of psychiatric problems were three times more apt to be given antipsychotics than other residents. Those with an anxiety disorder were four times more apt to receive antianxiety/hypnotic drugs than other residents in 1993.

Nursing home facility factors also were less important in influencing psychotropic drug use in 1993 compared with 1990. The author cautions, however, that the changes in psychotropic drug use may not have been specifically related to the NHRA but may instead have been due to increased knowledge about the appropriate indications for psychotropic drug use.

More details are in "Changes in resident and facility risk factors for psychotropic drug use in nursing homes since the Nursing Home Reform Act," by Dr. Castle, in the March 1999 Journal of Applied Gerontology 18(1), pp. 77-98.

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