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

解决辅助生活中的行为和情绪：与使用抗精神病药物和精神药物以及替代做法相关的组织特征

• 批准号: 9132160
• 负责人: Sheryl Zimmerman
• 金额: $ 60.91万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9132160
• 关键词: Acute; Address; Admission activity; Adverse effects; Advocacy; Affective; Age; American; Antidepressive Agents; Antipsychotic Agents; Assisted Living Facilities; Attention; Attitude; Beds; Behavior; Behavior Control; Behavioral; Behavioral Symptoms; Benchmarking; Boxing; Caring; Case Mixes; Characteristics; Clinical; Clinical Services; Cognitive; Country; Data; Dementia; Distress; Dose; Education; Elderly; Family; Frequencies; Health; Health Personnel; Health Professional; Health Services; Healthcare; Hospitalization; Impaired cognition; Individual; Influentials; Intervention; Life; Long-Term Care; Medical; Medicine; Mental Health; Modification; Moods; Nursing Homes; Nursing Staff; Pattern; Persons; Pharmaceutical Preparations; Physicians; Policies; Positioning Attribute; Prevalence; Protocols documentation; Psychiatric Diagnosis; Psychotropic Drugs; Recording of previous events; Regulation; Research; Risk; Sampling; Sensory; Societies; Training; United States Centers for Medicare and Medicaid Services; United States Food and Drug Administration; Writing; base; depressive symptoms; education research; environmental intervention; evidence base; hospice environment; information organization; mild cognitive impairment; person centered; policy implication; psychosocial; residence; response

 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.

 描述（由适用提供）：使用抗精神病药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已成为全国性的关注。 2011年，尽管联邦食品药品监督管理局发出了强烈的“黑匣子警告”，但有24％的护理人员居民接受了抗精神病药，但他们危及生命的不良反应风险，以及有效的非药物替代方案。作为回应，2012年，Medicare＆Medicaid Services中心发起了一项全国性倡议，迄今为止，迄今为止，护士家庭中的抗精神病药物减少了17％。新兴的证据表明，对辅助居民（ALR）也关注严重原因，这为近750,000名老年人提供了照顾。 70％的辅助生活居民患有认知障碍，38％的行为症状，而25％的人患有抑郁症状。新数据表明，有69％的ALR定期服用对控制行为的药物，有57％的患有行为症状的居民被处方药物，其中包括没有认知障碍的42％，只有46％的人只有轻度的认知障碍。此外，无执照的员工在20％以上的ALR中管理药物，这些同一个人确定何时“根据需要”（Pro Re）NATA； PRN）应服用药物。因此，毫不奇怪，对辅助生活中的抗精神病药处方的担忧已成为众多组织的关注点。尽管引起了人们的关注和民族的关注，但在ALRS中实际使用抗精神病药和其他精神药物的信息不足，几乎没有关于最有可能使用的环境的信息以及实施基于证据的护理替代方案的可行性。因此，不可能制定政策和基准来促进护士之家现在发生的更好的护理。作为回应，由临床和卫生服务专家在辅助生活研究方面进行的该项目 - 密切参与了由国家和州领导人组成的顾问委员会参与ALR政策，法规，实践，教育和倡导 - 将获得并传播信息，以帮助利益相关者了解问题的范围并促进变化。具体而言，在该国两个地区的七个州的280个ALR的分层随机样本中，拟议的研究将确定（1）抗精神病药和其他精神药物使用的范围和模式； （2）与药物使用有关的组织和人级特征，并有可能不适当的处方； （3）使用或可行的替代策略来解决居民困扰。它还（4）将结果传播到实践，政策和倡导利益相关者。假设抗精神病药和其他精神药物使用以及实施基于证据的非药物实践的能力将与对政策和实践产生影响的可修改组织特征有关。