Patterns and correlates of atypical and conventional antipsychotic use in nursing homes

Little information exists about the use of atypical antipsychotics in nursing homes. We describe the patterns of atypical and conventional antipsychotic use among nursing home residents. We used the Minimum Data Set (1998-2000) in 6 states. We identified 150,316 residents in 1,834 facilities systematically collecting detailed drag information. Sixty two percent were classified as 'high risk' according to the HCFA antipsychotic use quality indicator. Eighteen percent used antipyschotics, with the majority of use atypical. The most frequently used antipsychotics were risperidone and haloperidol. Overall, resident characteristics of atypical vs. conventional antipsychotic users were similar with the exception of depression (51% vs. 38%, for atypical vs. conventional) and use of antidepressants (50% vs. 37%, for atypical vs. conventional). In a relatively short period of time, atypical antipsychotics have attained a major presence in nursing homes. Given that resident characteristics little explain the choice of antipsychotic used, contextual factors should be evaluated.