Antipsychotic use in assisted living communities varies greatly across U.S. states, study finds

Lacking federal guidelines, health care professionals in state-regulated facilities determine dosing for seniors with dementia, greatly impacting the care residents receive.

Antipsychotic medications are drugs that are sometimes used to treat behavioral problems in people with dementia, but they can have serious side effects, including fall-related injuries, cardiovascular events, and even mortality. Despite Black Box Warnings from the US Food and Drug Administration, these drugs are still commonly prescribed in assisted living communities, where there are no consistent policies regulating their use.

Unlike nursing homes, which are subject to federal oversight, individual states regulate assisted living communities. This has led to wide variations in the care provided to residents of assisted living communities with dementia and the management of antipsychotic prescribing.In a recent study published in the Journal of Post-Acute and Long Term Care Medicine (JAMDA), researchers from the Brown University School of Public Health and the Institute for Healthcare Policy and Innovation at the University of Michigan conducted a one-year observational study to examine how antipsychotic prescribing among residents of assisted living (AL) communities with dementia varied across states. They looked at Medicare records for a representative sample of people aged 65 or older from 2017.

“The overuse of antipsychotic medications in these populations can have serious consequences, such as increased mortality and stroke,” said Tingting Zhang, primary investigator of the study and assistant professor of health services, policy and practice at the School of Public Health. “Our study highlights the need to identify which state regulations are effective in reducing antipsychotic use among AL residents with dementia.”

Professor Zhang and her team found that, on average, people with dementia living in assisted living communities had a prescription for an antipsychotic filled during 12.6% of their months in care. However, the rate varied greatly between different states, from a low of 7.8% in Hawaii to a high of 20.5% in Wyoming. The majority of states had an average exposure rate between 10% and 15%.

“Each state regulates these communities differently, which can greatly impact the care residents receive,” explained Zhang. “For example, some states have implemented regulations prohibiting the use of chemical restraints, like antipsychotic medications, while others have not. This has led to significant variations in the levels of care and use of antipsychotics among residents with dementia.” 

Zhang and her team suggest further investigation is needed to better understand and address the significant differences in prescribing protocol across states. “Providing quality care for people with dementia living in assisted living communities is a complex issue that requires a comprehensive approach,” she said. “To improve the safety and well-being of this vulnerable population, it’s essential to understand which policies are effective in reducing antipsychotic use and develop strategies to prioritize their care.”