Psychoactive medication therapy and delirium screening in skilled nursing facilities. Issue 5 (21st January 2022)

• Record Type: Journal Article
• Authors: Briesacher, Becky A.; Olivieri‐Mui, Brianne L.; Koethe, Benjamin; Saczynski, Jane S.; Fick, Donna Marie; Devlin, John W.; Marcantonio, Edward R.
• Is Part Of: Journal of the American Geriatrics Society. Volume 70:Issue 5(2022)
• Page Start: 1517
• Page End: 1524
• Publication Date: 2022-01-21
• Subjects: delirium -- dementia -- prescribing -- skilled‐nursing facilities; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.17662
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract: Background: A positive delirium screen at skilled‐nursing facility (SNF) admission can trigger a simultaneous diagnosis of Alzheimer's Disease or related dementia (AD/ADRD) and lead to psychoactive medication treatment despite a lack of evidence supporting use. Methods: This was a nationwide historical cohort study of 849, 086 Medicare enrollees from 2011–2013 who were admitted to the SNF from a hospital without a history of dementia. Delirium was determined through positive Confusion Assessment Method screen and incident AD/ADRD through active diagnosis or claims. Cox proportional hazard models predicted the risk of receiving one of three psychoactive medications (i.e., antipsychotics, benzodiazepines, antiepileptics) within 7 days of SNF admission and within the entire SNF stay. Results: Of 849, 086 newly‐admitted SNF patients (62.6% female, mean age 78), 6.1% had delirium (of which 35.4% received an incident diagnosis of AD/ADRD); 12.6% received antipsychotics, 30.4% benzodiazepines, and 5.8% antiepileptics. Within 7 days of admission, patients with delirium and incident dementia were more likely to receive an antipsychotic (relative risk [RR] 3.09; 95% confidence interval [CI] 2.99 to 3.20), or a benzodiazepine (RR 1.23; 95% CI 1.19 to 1.27) than patients without either condition. By the end of the SNF stay, patients with both delirium and incident dementia were more likely to receive an antipsychotic (RR 3.04; 95% CI 2.95 to 3.14) and benzodiazepine (RR 1.32; 95% CI 1.29 to 1.36) than patients without either condition. Conclusion: In this historical cohort, a positive delirium screen was associated with a higher risk of receiving psychoactive medication within 7 days of SNF admission, particularly in patients with an incident AD/ADRD diagnosis. Future research should examine strategies to reduce inappropriate psychoactive medication prescribing in older adults admitted with delirium to SNFs.