Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 51, Issue 3 M131-M141, Copyright © 1996 by The Gerontological Society of America
Regulatory environment and psychotropic use in board-and-care facilities: results of a 10-state study
D Spore, V Mor, EP Larrat, J Hiris and C Hawes
Center for Gerontology and Health Care Research, Brown University, USA.
BACKGROUND. Largely unsupervised administration of drugs and the potential
for overuse of psychotropic agents in residential care facilities have
emerged as major public policy concerns. In a large multistate study, we
examined patterns of psychotropic prescription and use by facility
licensure status and the extensiveness of state regulations. METHODS.
Descriptive analyses were based on a sample of 2,949 residents from 493
board-and-care facilities in 10 states, drawn via a complex, multistage
sampling design. States were purposively selected based on the stringency
of their board-and-care regulatory system, and samples of facilities were
drawn, stratified by licensure status and home size. Residents were
randomly selected within the sampled facilities. Weighted analyses were
performed with Software for Survey Data Analysis (SUDAAN), accounting for
the complex sampling design. RESULTS. Approximately 43% of the residents
were prescribed and 41% used at least one psychotropic agent, primarily on
a routinely scheduled basis. Antipsychotics were prescribed to 22% and used
by 21%; antidepressants were prescribed to 17% and taken by 16%; antimanic
agents were prescribed to and used by 4%; and anxiolytics, sedatives, or
hypnotics were prescribed to 17% and used by 14%. Among psychotropic users,
over 50% had not had mental health services in the prior year; 25% had no
psychiatric history. Among licensed facilities, prescription and use of
psychotropics, particularly antipsychotics, was significantly higher among
residents of homes located in states with limited regulatory systems.
CONCLUSIONS. Results revealed high rates of psychotropic prescription and
use, and not inconsequential levels of polypharmacy - within and across
therapeutic classes - among board-and- care facility residents. Frequently,
psychotropics were not used as an adjunct to alternative treatments, and
were not associated with a psychiatric history. Extent of psychotropic use
was related to the regulatory environment, suggesting that more extensive
regulations and monitoring may reduce psychoactive drug use in
board-and-care facilities, and more adequately ensure the appropriateness
of such treatment.
