Bron Morgan, Aweh Gideon, Jen Eric, Patel Amita
Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA.
STATinMED, LLC, Dallas, TX, USA.
Neurol Ther. 2025 Sep 4. doi: 10.1007/s40120-025-00820-z.
Tardive dyskinesia (TD), a persistent and often debilitating movement disorder, is associated with prolonged exposure to dopamine receptor-blocking agents. Individuals aged ≥ 60 years are at increased risk for TD and TD-related burden (e.g., impaired balance, difficulty swallowing), which can complicate management in long-term care (LTC) settings. We evaluated the prevalence of TD diagnoses and characterized the populations, treatment patterns, and healthcare resource utilization within specific LTC settings.
This retrospective, longitudinal, observational study used the STATinMED Real-World Insights Database (1/2017-12/2012). Commercial, Medicaid, and Medicare enrollees with a TD diagnosis code who had ≥ 1 LTC stay, continuous claims data capture for ≥ 1 year pre-LTC facility admission, and ≥ 1 year post-LTC facility discharge were included. Demographics and clinical characteristics were captured for 12 months pre-LTC index stay. Clinical outcomes were collected for 12 months post-index LTC stay.
Of 20,176 patients identified, 2294 had ≥ 2 years continuous benefits and were included. Most patients were aged ≥ 65 years (64.6%), female (67.3%), and Medicare enrollees (76.8%). Mean Charlson Comorbidity Index score was 3.72 (standard deviation: 4.2) for all patients, suggesting high comorbidity burden. Two-thirds (66.1%) of the population had mood disorders, and antidepressants were the most widely used medication (56.1%). Polypharmacy was prevalent: nearly half (47.9%) of the population was prescribed ≥ 3 medications with central nervous system properties, which can increase risk of falls and cognitive impairment in older adults; 64.8% of patients had ≥ 1 emergency department visit any time post-LTC stay.
Our findings demonstrated individuals with TD in LTC settings have a high comorbidity burden and polypharmacy, particularly for medications with anticholinergic properties. Further investigation is warranted to evaluate the impact of TD in older adults in LTC settings and explore interventional practices that can improve clinical outcomes, such as falls with injury and activities of daily living decline.
迟发性运动障碍（TD）是一种持续存在且常使人衰弱的运动障碍，与长期接触多巴胺受体阻滞剂有关。年龄≥60岁的个体患TD及TD相关负担（如平衡受损、吞咽困难）的风险增加，这可能使长期护理（LTC）机构中的管理变得复杂。我们评估了TD诊断的患病率，并对特定LTC机构中的人群、治疗模式和医疗资源利用情况进行了描述。
这项回顾性、纵向观察性研究使用了STATinMED真实世界洞察数据库（2017年1月至2012年12月）。纳入有TD诊断代码、有≥1次LTC住院经历、在LTC机构入院前≥1年及出院后≥1年有连续索赔数据记录的商业保险、医疗补助和医疗保险参保者。在LTC索引住院前12个月收集人口统计学和临床特征。在索引LTC住院后12个月收集临床结局。
在识别出的20176例患者中，2294例有≥2年的连续保险福利并被纳入研究。大多数患者年龄≥65岁（64.6%），女性（67.3%），医疗保险参保者（76.8%）。所有患者的平均查尔森合并症指数评分为3.72（标准差：4.2），表明合并症负担较高。三分之二（66.1%）的人群患有情绪障碍，抗抑郁药是使用最广泛的药物（56.1%）。多重用药很普遍：近一半（47.9%）的人群被开具了≥3种具有中枢神经系统特性的药物，这可能增加老年人跌倒和认知障碍的风险；64.8%的患者在LTC住院后的任何时间都有≥1次急诊就诊。
我们的研究结果表明，LTC机构中患有TD的个体合并症负担高且多重用药，尤其是使用具有抗胆碱能特性的药物。有必要进一步研究，以评估TD对LTC机构中老年人的影响，并探索可改善临床结局（如跌倒受伤和日常生活活动能力下降）的干预措施。
