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Geographic Variation of Antidementia and Antipsychotic Medication Use Among US Nursing Home Residents With Dementia
Alison C. Rataj, Matthew James Alcusky, Jonggyu Baek, Brian R. Ott, Kate L. Lapane. Medical Care, 2024-05-29
Topic: Risk, prevention and care in population studies
memantine, cholinesterase inhibitor (ChEI), antipsychotic use] estimated adjusted odds ratios (aOR) and 95% CIs for resident, facility, and HRR characteristics. We then fit a series of cross-classified multilevel logistic models to estimate the proportional change in cluster variance (PCV). Overall, 20.9% used antipsychotics, 16.1% used memantine, and 23.3% used ChEIs. For antipsychotics, facility factors [eg, use of physical restraints (aOR: 1.08; 95% CI: 1.05-1.11) or poor staffing ratings (aOR: 1.10; 95% CI: 1.06-1.14)] were associated with more antipsychotic use. Nursing homes in HRRs with the highest health care utilization had greater antidementia drug use (aOR memantine: 1.68; 95% CI: 1.44-1.96). Resident/facility factors accounted for much regional variation in antipsychotics (PCV STATE : 27.80%; PCV HRR : 39.54%). For antidementia medications, HRR-level factors accounted for most regional variation (memantine PCV STATE : 37.44%; ChEI PCV STATE : 39.02%). Regional variations exist in antipsychotic and antidementia medication use among nursing home residents with dementia suggesting the need for evidence-based protocols to guide the use of these medications.
Key findings
- memantine, cholinesterase inhibitor (ChEI), antipsychotic use] estimated adjusted odds ratios (aOR) and 95% CIs for resident, facility, and HRR characteristics.
- We then fit a series of cross-classified multilevel logistic models to estimate the proportional change in cluster variance (PCV).
- Overall, 20.9% used antipsychotics, 16.1% used memantine, and 23.3% used ChEIs.
- For antipsychotics, facility factors [eg, use of physical restraints (aOR: 1.08; 95% CI: 1.05-1.11) or poor staffing ratings (aOR: 1.10; 95% CI: 1.06-1.14)] were associated with more antipsychotic use.
- Nursing homes in HRRs with the highest health care utilization had greater antidementia drug use (aOR memantine: 1.68; 95% CI: 1.44-1.96).
Why it matters
This study found regional differences in the use of antipsychotic and antidementia medications among nursing home residents with dementia. It suggests that evidence-based protocols are needed to guide the use of these medications, but it does not test any treatment for curing or preventing Alzheimer's disease.
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Study details
- Participants9,735
- Effect size20.9%; 16.1%; 23.3%
- Evidence strengthLow
How this study scored 49/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Medical Care) |
| Journal's citation record | 3 / 4 | Medical Care: journal h-index 273 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 9,735 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 9 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.2 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 2 / 6 | Cited 2.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 1 / 4 | Cited 8 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Kate L. Lapane: h-index 69 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Brown University: institution h-index 1,120 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 38833712) |
| Free to read | 2 / 2 | Free to read |
| Total | 49 / 100 | — |
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Read the original
- DOI: 10.1097/mlr.0000000000002016
- PubMed: 38833712
- Original source →
- Free full text: Europe PMC (PubMed Central) →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Rataj, A. C., Alcusky, M. J., Baek, J., Ott, B. R., & Lapane, K. L. (2024). Geographic Variation of Antidementia and Antipsychotic Medication Use Among US Nursing Home Residents With Dementia. Medical Care. https://doi.org/10.1097/mlr.0000000000002016
Vancouver
Rataj AC, Alcusky MJ, Baek J, Ott BR, Lapane KL. Geographic Variation of Antidementia and Antipsychotic Medication Use Among US Nursing Home Residents With Dementia. Medical Care. 2024. doi:10.1097/mlr.0000000000002016. PMID: 38833712.
BibTeX
@article{rataj2024-38833712,
author = {Rataj, Alison C. and Alcusky, Matthew James and Baek, Jonggyu and Ott, Brian R. and Lapane, Kate L.},
title = {{Geographic Variation of Antidementia and Antipsychotic Medication Use Among US Nursing Home Residents With Dementia}},
journal = {Medical Care},
year = {2024},
doi = {10.1097/mlr.0000000000002016},
pmid = {38833712},
url = {https://doi.org/10.1097/mlr.0000000000002016}
}
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