Linda Wastila, BSPharm, MSPH, PhD, the Parke-Davis Chair in Geriatric Pharmacotherapy in the Department of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy (UMSOP), has received a three-year, $1.6 million grant from the National Institutes of Health to investigate how a recent nationwide initiative to reduce the use of antipsychotic medications among older adults in long-term care facilities has impacted the use of other medications at those facilities, as well as patient health outcomes.
“The organizations involved in this initiative have done an excellent job reporting the reductions in the use of antipsychotics, but our team will be the first to examine how efforts to reduce the use of this class of medications impacts the use of other medications and health outcomes for older adults in long-term care facilities,” says Wastila, who also serves as the director of research for the Peter Lamy Center on Drug Therapy and Aging at UMSOP. “We hope reductions in the use of antipsychotics are favorable for these patients, but this study will allow us, as drug safety experts, to truly quantify to real-world impact of this initiative.”
Antipsychotics are a class of medications primarily used to manage symptoms associated with psychosis, including delusions, hallucinations, and paranoia. While these medications are typically used to treat patients diagnosed with conditions such as schizophrenia and bipolar disorder, some health care professionals also prescribe them to patients diagnosed with Alzheimer’s disease and other related dementias. Prolonged use of these medications is associated with a number of adverse effects, which can be particularly detrimental for older adults.
The national initiative leading the effort to reduce the use of antipsychotic medications among older adults in long-term care facilities is known as the National Partnership to Improve Dementia Care. It is a private-public coalition established in 2012 that includes the Centers for Medicare and Medicaid Services (CMS), consumers, advocacy organizations, health care providers, and professional associations. Within five years of its launch, the initiative saw a 34.1 percent reduction in the use of antipsychotics across all long-term care facility residents, to a national annual prevalence of 15.7 percent — a number that continues to decrease each year.
“We absolutely believe that antipsychotics have been overused in the general population, as well as in long-term care facilities,” Wastila says. “But we are also concerned about the inadvertent, but very real, impact that a policy such as this might have when the only goal is to reduce the use of these medications by a certain percentage. We don’t know what those impacts might be at this time. Were these patients switched to other medications? What impact might those medication changes have had on patients?”
For Wastila, who was named Researcher of the Year for the University of Maryland, Baltimore (UMB) in 2016, this study represents a continuation of her well-recognized work examining drug use among older adults. She and her team will use advanced methodological approaches and comprehensive national data — including a nationally representative, 100 percent sample of Medicare beneficiaries who resided in long-term care facilities from 2010 to 2016 — to assess state-, facility-, and individual-level characteristics that might have mediated the impacts of the nationwide initiative that affected more than 1.4 million long-term care facility residents. The team will focus on residents with Alzheimer’s disease and related dementias to assess the initiative’s impact on changes in the use of antipsychotics; potentially harmful use of other psychopharmacological medications, such as opioids, antidepressants, and anticonvulsants; and selected public health and individual patient health outcomes.
“One element of this study that really excites our team is that we have the opportunity to build a close-to-100-percent sample of all Medicare beneficiaries who resided in long-term care facilities for an extended period of time,” Wastila says. “Oftentimes, the sample sizes used in studies such as this one are too small to allow us to see what is going on at the facility level. For this study, we can look at all of the patients in all of the facilities that receive funding from Medicare — that is approximately 90 to 95 percent of all long-term care facilities in the nation.”
She adds, “It also allows us to look at how facility characteristics — such as size, profit status, and staffing patterns — influence antipsychotic and other medication use and outcomes.”
The ultimate goal of the research is to provide guidance to health care providers and policymakers on how to optimize prescribing decisions and policies that support the health and quality of life of older adult patients in long-term care facilities.
“We truly want to affect policy change for patients residing in long-term care facilities across the United States,” Wastila says. “If we find that there was a substitution effect for certain antipsychotic medications that showed a reduction in use among this population, we want to help ensure that mechanisms are implemented to prevent patients from being switched from one harmful medication to another potentially dangerous drug. However, if we find that there were no problems related to individual health outcomes or substitutions for other medications, then that is tremendous, and we can all feel good about this initiative that positively affected a national population.”