The impact of legislation on psychotropic drug use in nursing homes: A cross-national perspective.

OBJECTIVES: To quantify the impact of legislation on nursing home residents , psychotropic drug use, and the occurrence of falls in the US compared wit h five countries with no such regulation. DESIGN: A retrospective cross-sectional study SETTING: Nursing homes in five US states and selected nursing homes in Denm ark, Iceland, Italy, Japan, and Sweden PARTICIPANTS: Residents in nursing homes in five US states and the aforemen tioned countries during 1993-1996 MAIN OUTCOME MEASURES: Using data collected using the Minimum Data Set, log istic regression provided estimates of the legislative effects on the use o f antipsychotics and antianxiety/hypnotics while simultaneously adjusting f or potential confounders. The occurrence of falls was evaluated similarly. RESULTS: Prevalence of antipsychotic and/or antianxiety/hypnotic use varied substantially across countries. After adjustment for differences in age, g ender, presence of psychiatric/neurologic conditions, and physical and cogn itive functioning, residents in Denmark, Italy, and Sweden were at least tw ice as likely to receive these drugs (Denmark Odds Ratio (OR)=2.32; 95% Con fidence Intervals (CI), 2.15-2.51; Italy OR=2.05; 95% CI, 1.78-2.34; Sweden OR=2.50; 95% CI, 2.16-2.90); in Iceland, the risk was increased to greater than 6 times (OR=6.54; 95% CI, 5.75-7.44) that of the US. Residents were l ess likely to fall in Italy, Iceland, and Japan compared with the US, despi te more extensive use of psychotropic medication, whereas residents in Swed en and Denmark were more likely to fall. CONCLUSIONS: Policy has had an impact on the prescribing of psychotropic me dication in US nursing homes compared with other countries, but it is uncle ar if this is translated into better outcomes for residents.