HealthDay News — Nearly one-quarter of nursing home residents are prescribed one or more antipsychotic agents, generally off-label, a national analysis revealed.

In a sample of more than 1 million patients in nursing homes, 22% (95% CI 21.9 to 22.1) were given at least one prescription for an antipsychotic agent, Becky A. Briesacher, PhD, and colleagues from the University of Massachusetts in Worcester reported in the Journal of the American Medical Association.

“The prescribing of antipsychotic medications persists at high levels in U.S. nursing homes despite extensive data demonstrating marginal clinical benefits and serious adverse effects, including death,” the researchers wrote.

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To better understand the prevalence of antipsychotic use in this population  Briesacher and colleagues analyzed 2009-2010 prescription dispensing data from a large, long-term care pharmacy (Omnicare Inc.) that serves 48 states and half of all U.S. nursing home residents.

Claims data included reimbursement verification, as well as information on patients’ age, sex and location of residence. A total of 1,402,039 individuals were included in the study, along with a subset of 561,681 patients who had at least three months of continuous observation.

A total of 308,449 participants were given at least one prescription for an antipsychotic. The majority of antipsychotics prescribed — more than two-thirds — belonged to the atypical class.

Primarily indicated for the treatment of schizophrenia and bipolar disorder, these included quetiapine fumarate (Seroquel), at 31.1%; risperidone (Risperdal), at 24.4%; and olanzapine (Zyprexa), at 13.1%.

Among the subgroup of participants with three-month follow-up data, median duration of use was 70 days or more for all three. Only 7.5% of the subgroup had been given just one antipsychotic prescription; the median number of such prescriptions was 10.

The researchers also observed considerable geographic variation in prescribing patterns, suggesting lack of an evidence-based approach. States in the Central South were in the highest quintile for prescribing atypical antipsychiotics, with a mean 28.1% (95% CI: 27%-29.1%) of nursing home residents in these states receiving at least one of these drugs. States in the lowest quintile were primarily in the West, with a 17.2% (95% CI: 16.3-18.1) of patients given one or more antipsychotic agents.

The 22% 2009 to 2010 rate is within the lower range of prevalence documented 25 years earlier, before the passage of the Omnibus Budget Reconciliation Act of 1987 — legislation that regulated appropriate use of antipsychotics in nursing homes, the researchers acknowledged.

Study limitations included use of a single long-term-care pharmacy for data and inability to determine whether the prescribing practices could be considered appropriate.


  1. Briesacher B et al “Antipsychotic use among nursing home residents.” JAMA 2013; 309: 440-442.