Antidepressants in nursing homes for dependent older patients: the cross-sectional associations of institutional factors with prescription conformance.

PURPOSE

Depression is diagnosed in approximately 40% of the nursing home (NH) residents, but the pertinence of the high use of antidepressants is often criticized. We aimed at determining the proportion of non-conforming antidepressant prescriptions among NH residents and the associated institutional and demographic factors.

METHODS

Cross-sectional study of 2651 residents in 175 French NH participating in the IQUARE study (Impact of a QUAlity process on the development of practices and the functional decline of NH REsidents) and treated with antidepressants. Diagnosis of depression was obtained from the medical records. Antidepressant treatments were identified on the prescriptions and their conformance was analyzed in light of the international practice guidelines (i.e., indication, drug class, duplication, and monitoring).

RESULTS

A total of 1017 residents (38.4%) had a non-conforming prescription. Availability of a list of recommended medications for older patients (OR = 1.39, 95% CI [1.15; 1.68], p < 0.001) and regular intervention by a psychiatrist/psychiatric nurse in the facility (OR = 1.50, 95% CI [1.26; 1.77], p < 0.001) were associated with better antidepressant conformance. Women (OR = 0.76, 95% CI [0.61; 0.93], p < 0.05) and residents on multiple drugs (OR = 0.64, 95% CI [0.50; 0.80], p < 0.001) were at higher risk for non-conforming antidepressant prescription. A history of dementia (OR = 1.54, 95% CI [1.29; 1.84], p < 0.001), co-prescription of neuroleptics (OR = 4.23, 95% CI [2.20; 8.12], p < 0.001), and a known date of psychotropic initiation (OR = 2.58, 95% CI [2.10; 3.16], p < 0.001) were associated with better antidepressant conformance.

CONCLUSIONS

Our results suggest that a "quality process" by the NH combining accessible psychiatric care in facilities, pharmacological monitoring, and prescription improvement actions might optimize antidepressant prescribing for residents.