Antiepileptic Med Use Increasing in Nursing Home Residents With Dementia

The two most common, valproic acid and gabapentin, being used in clinically distinct ways

THURSDAY, Nov. 10, 2022 (HealthDay News) — Antiepileptic prescribing among nursing home residents with Alzheimer disease and related dementias (ADRD) is increasing, according to a study published online Nov. 9 in the Journal of the American Geriatrics Society.

Molly Candon, Ph.D., from University of Pennsylvania in Philadelphia, and colleagues measured the proportion of residents with ADRD in nursing homes nationwide (2015 to 2019) with at least one antiepileptic prescription, as well as trends in valproic acid, gabapentin, antipsychotic, and opioid prescribing. Differences in prescribing rates based on whether residents with ADRD had disruptive behaviors or reported pain were examined. The analysis included 973,074 persons with a nursing home stay of at least three months.

The researchers found that the proportion of residents with ADRD with at least one antiepileptic prescription increased from 29.5 percent in 2015 to 31.3 percent in 2019, which was driven by increases in the rate of valproic acid and gabapentin prescribing. There were declines noted in antipsychotic prescribing rates (32.1 to 27.9 percent) and opioid prescribing rates (39.8 to 31.7 percent) during the study period. Among residents with ADRD with disruptive behaviors, the risk for valproic acid prescribing was 10.9 percentage points higher, while the risk for being prescribed gabapentin was 13.9 percentage points higher among residents with ADRD reporting pain.

“Antiepileptic prescribing of questionable risk-benefit for dementia care warrants further scrutiny,” the authors write.

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