Study finds potentially suboptimal use of antidepressants for residents in Veterans Affairs nursing homes
Older residents in Veterans Affairs (VA) Community Living Centers (CLCs), the equivalent of nursing homes, often fail to get optimal treatment with antidepressant drugs, concludes a new study. It found that 25 percent of the 877 residents with depression did not receive antidepressant drugs. In addition, 58 percent of the 654 residents with depression and receiving antidepressant medication had evidence of possible inappropriate use (most commonly, potential drug-drug or drug-disease interactions). Among the 2,815 residents without diagnosed depression, 42 percent received at least one antidepressant drug. Depressed black residents were about half as likely as depressed whites to experience potential inappropriate use, while depressed residents with cancer were less likely to experience either possible underuse or inappropriate use.
The researchers also found that nondepressed residents who received antipsychotic drugs without a diagnosis of schizophrenia and or those with a history of stroke or anxiety were about 1.5 times more likely to be given an antidepressant. The findings were based on data on 3,692 veterans admitted to 133 VA CLCs over a 17-month period ending in early June 2005. The CLCs were from 21 VA regions across the United States. The study was funded in part by the Agency for Healthcare Research and Quality (HS17695, HS18721, and HS19461).
More details are in "Potential underuse, overuse, and inappropriate use of antidepressants in older veteran nursing home residents," by Joseph T. Hanlon, Pharm.D., M.S., Xiaoqiang Wang, M.S., Nicholas G. Castle, Ph.D., and others in the August 2011 Journal of the American Geriatric Society 59(8), pp. 1412-1420.
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