Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-up

OBJECTIVE: To analyse the use of antipsychotic medications, change over time and associated factors in a three-year follow-up among elderly residents in long-term institutional care. DESIGN: Retrospective study was designed with three identical cross-sectional samples originating from the same long-term care facilities, and collected 1 July to 31 December in 2001, 2002 and 2003, in Finland. These were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set (MDS) assessments. SETTING: Of the data providers 16 were hospital-based institutions and 25 residential homes. PARTICIPANTS: Each of the data sets included 3,662-3,867 resident assessments. RESULTS: The prevalence use of one or more antipsychotic decreased from 42% in 2001 to 39% in 2003. The overall confounder-adjusted decrease in antipsychotic use was not statistically significant. However, the use of antipsychotics decreased among residents who had wandering as a behavioural problem (OR 0.79, 95% CI 0.63-0.99) and increased among residents with concomitant use of anxiolytic medications (OR 1.23, 95% CI 1.03-1.48). CONCLUSIONS: The use of antipsychotic medications among residents in long-term institutional care was common and the caring patterns were quite stable during the observation period. Adequate indications may not have been achieved in all cases. More attention should be paid to the appropriate use of antipsychotics in this frail population.