Study Suggests Potential Problems with the Use of Antidepressants among Older Veterans Residing in VA Nursing Homes
Depression is common among older nursing home patients, and antidepressant therapy is the most common treatment for this patient population. Moreover, the prevalence of antidepressant use in U.S. nursing home patients has increased more than 100% — from 22% in 1996 to 48% in 2006. This longitudinal study examined the prevalence and patient/site-level factors associated with potential underuse, overuse, and inappropriate use of antidepressants among 3,692 Veterans aged 65 years and older that were admitted to any one of 133 VA Community Living Centers (CLC, previously called Nursing Home Care Units). Veterans with and without depression (877 vs. 2,815) were admitted to CLCs between 1/04 and 6/05 and had stays of 90 days or longer. In addition to assessing antidepressant use, investigators also examined demographics, health status factors, and psychiatric/neurological problems.
Findings suggest potential problems with the use of antidepressants in older Veterans that reside in VA Community Living Centers. Overall, only 18% of antidepressant use was optimal. Of the 877 Veterans with depression, 25% did not receive an antidepressant, suggesting potential underuse. Among depressed Veterans who received antidepressants, 43% had potential inappropriate use due primarily to problems seen with drug-drug and drug-disease interactions. In addition, of the 2,815 Veterans who did not have depression, 42% were prescribed one or more antidepressants; of these, only 4% had an FDA-approved labeled indication, suggesting potential overuse. Also, the co-prescribing of antipsychotics (in patients without schizophrenia) among those without depression was associated with an increased risk of antidepressant overuse. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed antidepressants among both groups.
The authors suggest future studies to examine the true risks and benefits of antidepressant use in VA nursing homes.
Hanlon J, Wang X, Castle N, et al. Potential underuse, overuse, and inappropriate use of antidepressants in older Veteran nursing home patients. Journal of the American Geriatrics Society August 2011;59(8):1412-20.
This study was partly funded by HSR&D (IIR 06-062). Dr. Hanlon and Mr. Wang are part of HSR&D’s Center for Health Equity Research and Promotion in Pittsburgh, PA.