PSYCHOTROPIC USE AMONG OLDER RESIDENTS OF BOARD AND CARE FACILITIES

OBJECTIVE: To describe patterns of psychotropic use as well as clinica lly relevant and concurrent nonpsychotropic use among older residents of board and care facilities in 10 states. METHODS: Weighted use rates were based on data from a sample of 2054 residents aged 65 and older from 410 facilities in 10 states, drawn via a complex, multistage samp ling design. Data, including drug name, use frequency, and PRN use, we re collected on all drugs taken by the resident during a 7-day period. During face-to-face interviews with residents and/or proxies, data we re also collected on resident characteristics. SUBJECTS: The majority of subjects were female, white, and widowed. Average age was 82 years. Approximately 25% had a current mental or emotional condition, and 8% had been hospitalized for a psychiatric condition during the year bef ore admission. More than half needed help with at least one activity o f daily living. Forty percent had moderate or severe cognitive impairm ent, and 18% had received mental health care during the previous year. ANALYSES: Weighted descriptive analyses were performed with Software for Survey Data Analysis (SUDAAN), which accounts for the complex, mul tistage sampling design. RESULTS: Approximately 35% of the older resid ents used at least one psychoactive agent, with 30% of psychotropic us ers receiving two to four different psychotropic medications. Use rate s decline with age, for psychotropics overall and for therapeutic clas ses. Results revealed potentially problematic polypharmacy in relation to drug duplication within therapeutic classes, use of multiple psych otropics across classes, and concurrent nonpsychotropic use. CONCLUSIO NS: Compared with community-dwelling older adults, this study revealed high psychotropic use rates among older board and care facility resid ents. Overall, our results suggest that serious consideration be given to the apparent need for systematic drug utilization review, a potent ially useful program that is mandated in other settings.