Addressing Behavior and Mood in Assisted Living: Organizational Characteristics Related to the Use of Antipsychotic and Psychotropic Medications and Alternative Practices

 描述(申请人提供)：使用抗精神病药物和其他精神药物来解决居住在长期护理环境中的老年人的行为和情绪问题已成为国家关注的问题。2011年，24%的疗养院居民接受了抗精神病药物治疗，尽管联邦食品和药物管理局就其危及生命的不良反应风险以及有效的非药物替代品的可用性发出了强烈的“黑匣子”警告。作为回应，2012年，医疗保险和医疗补助服务中心发起了一项全国性倡议，迄今已将疗养院抗精神病药物的使用减少了17%。新出现的证据表明，辅助生活住宅(ALR)也令人严重担忧，它为近75万老年人提供护理。70%的辅助生活居民有认知障碍，38%有行为症状，25%有抑郁症状。新的数据显示，69%的ALR定期服用药物来控制行为，57%的有行为症状的居民开了药物--其中42%的人没有认知障碍，46%的人只有轻微的认知障碍。此外，在超过20%的ALR中，无证工作人员给药，这些人决定何时应该根据需要(PRN；PRN)给药。因此，对辅助生活中抗精神病药物处方的担忧已成为许多组织关注的焦点也就不足为奇了。尽管有明显的关切和国家关注，但关于抗精神病药物和其他精神药物在急性呼吸综合征中的实际使用情况的信息不足，而且几乎没有关于它们最有可能在什么环境中使用以及实施循证护理替代方案的可行性的信息。因此，不可能制定政策和基准来促进更好的护理，就像现在疗养院所发生的那样。作为回应，该项目由辅助生活研究领域的临床和卫生服务专家实施，由ALR政策、法规、实践、教育和倡导方面的国家和州领导人组成的顾问委员会密切参与，该项目将获得和传播信息，以帮助利益相关者了解问题的范围并推动变革。具体地说，在美国两个地区的七个州的280个ALR的分层随机样本中，建议的研究将确定(1)抗精神病药物和其他精神药物的使用范围和模式；(2)与药物使用和可能不适当的处方有关的组织和个人层面的特征；以及(3)正在使用或可行的解决居民痛苦的替代策略。它还将(4)将结果传播给实践、政策和倡导利益相关者。假设抗精神病药物和其他精神药物的使用，以及实施循证的非药理学做法的能力，将与对政策和实践有影响的可改变的组织特征有关。

 DESCRIPTION (provided by applicant): The use of antipsychotic and other psychotropic medications to address behavior and mood among older adults residing in long-term care settings has become a national concern. In 2011, 24% of nursing home residents received antipsychotic medications, despite strong "black box warnings" issued by the federal Food and Drug Administration of their risk of life-threatening adverse effects, as well as the availability f effective non-pharmacological alternatives. In response, in 2012 the Centers for Medicare & Medicaid Services launched a national initiative that to date has reduced antipsychotic use in nursing homes by 17 percent. Emerging evidence suggests grave cause for concern in assisted living residences (ALRs) as well, which provide care for almost 750,000 older adults. Seventy percent of assisted living residents have cognitive impairment, 38% have behavioral symptoms, and 25% have symptoms of depression. New data indicate that 69% of ALRs regularly administer medication to control behavior, and 57% of residents with behavioral symptoms are prescribed a medication - including 42% who have no cognitive impairment and 46% who have only mild cognitive impairment. Further, unlicensed staff administer medications in more than 20% of ALRs, and these same individuals determine when an "as needed" (pro re nata; PRN) medication should be administered. It is no surprise, then, that concern about antipsychotic prescribing in assisted living has become a focus of attention for numerous organizations. Despite notable concern and national attention, there is insufficient information about the actual use of antipsychotic and other psychotropic drugs in ALRs, and virtually no information regarding the settings in which they are most likely to be used and the feasibility of implementing evidence-based alternatives to care. Consequently, it is not possible to develop policies and benchmarks to promote better care as is now occurring in nursing homes. In response, this project, conducted by clinical and health services experts in assisted living research - with close involvement of an advisory board composed of national and state leaders in ALR policy, regulation, practice, education, and advocacy - will obtain and disseminate information to help stakeholders understand the scope of the problem and promote change. Specifically, in a stratified random sample of 280 ALRs across seven states in two regions of the country noted to have the highest and lowest prescribing rates, the proposed study will ascertain (1) the scope and patterns of antipsychotic and other psychotropic medication use; (2) organizational and person-level characteristics related to medication use and potentially inappropriate prescribing; and (3) alternate strategies in use or feasible to address resident distress. It also will (4) disseminate the results to practice, policy, and advocacy stakeholders. t is hypothesized that antipsychotic and other psychotropic medication use, as well as the capacity to implement evidence-based, non-pharmacological practices, will relate to modifiable organizational characteristics that have implications for policy and practice.