{"doi":"10.1111/jgs.18119","title":"Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>Antiepileptics are commonly prescribed to nursing home residents with Alzheimer's disease and related dementias (ADRD) but there is little scientific support for their use in this population. It is unclear whether different antiepileptics are targeting different indications.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>Using the Minimum Data Set and Medicare data, including Part D pharmacy claims, we constructed annual cohorts of residents with ADRD with long‐term stays in nursing homes from 2015 to 2019. For each year, we measured the proportion of residents with ADRD in nursing homes nationwide with at least one antiepileptic prescription. We also measured trends in valproic acid, gabapentin, antipsychotic, and opioid prescribing. Finally, we examined how prescribing rates differed based on whether residents with ADRD had disruptive behaviors or reported pain.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Our study sample includes 973,074 persons living with ADRD who had a long‐term stay in a nursing home, which was defined as at least 3 months. The proportion of residents with ADRD with at least one antiepileptic prescription increased from 29.5% in 2015 to 31.3% in 2019, which was driven by increases in the rate of valproic acid and gabapentin prescribing. Conversely, antipsychotic prescribing rates declined from 32.1% to 27.9% and opioid prescribing rates declined from 39.8% to 31.7%. The risk of valproic acid prescribing was 10.9 percentage points higher among residents with ADRD with disruptive behaviors, while the risk of being prescribed gabapentin was 13.9 percentage points higher among residents with ADRD reporting pain.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>Antiepileptic prescribing among nursing home residents with ADRD is increasing, while antipsychotic and opioid prescribing is declining. Examining antiepileptic prescribing to residents with ADRD who had disruptive behaviors and/or reported pain suggests that two of the most common antiepileptics, valproic acid and gabapentin, are being used in clinically distinct ways. Antiepileptic prescribing of questionable risk–benefit for dementia care warrants further scrutiny.</jats:p>\n                  </jats:sec>","journal":"Journal of the American Geriatrics Society","year":2023,"id":650110,"datarank":0.49983067652628066,"base_score":3.332204510175204,"endowment":3.332204510175204,"self_citation_contribution":0.49983067652628066,"citation_network_contribution":0.0,"self_endowment_contribution":0.49983067652628066,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":27,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":721445,"name":"Julie Strominger","orcid":null,"position":1,"is_corresponding":false},{"id":720827,"name":"Lauren B. Gerlach","orcid":"0000-0003-1943-0150","position":2,"is_corresponding":false},{"id":335343,"name":"Donovan T. Maust","orcid":"0000-0003-4740-2640","position":3,"is_corresponding":false},{"id":578525,"name":"Molly Candon","orcid":"0000-0001-8312-951X","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>Antiepileptics are commonly prescribed to nursing home residents with Alzheimer's disease and related dementias (ADRD) but there is little scientific support for their use in this population. It is unclear whether different antiepileptics are targeting different indications.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>Using the Minimum Data Set and Medicare data, including Part D pharmacy claims, we constructed annual cohorts of residents with ADRD with long‐term stays in nursing homes from 2015 to 2019. For each year, we measured the proportion of residents with ADRD in nursing homes nationwide with at least one antiepileptic prescription. We also measured trends in valproic acid, gabapentin, antipsychotic, and opioid prescribing. Finally, we examined how prescribing rates differed based on whether residents with ADRD had disruptive behaviors or reported pain.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Our study sample includes 973,074 persons living with ADRD who had a long‐term stay in a nursing home, which was defined as at least 3 months. The proportion of residents with ADRD with at least one antiepileptic prescription increased from 29.5% in 2015 to 31.3% in 2019, which was driven by increases in the rate of valproic acid and gabapentin prescribing. Conversely, antipsychotic prescribing rates declined from 32.1% to 27.9% and opioid prescribing rates declined from 39.8% to 31.7%. The risk of valproic acid prescribing was 10.9 percentage points higher among residents with ADRD with disruptive behaviors, while the risk of being prescribed gabapentin was 13.9 percentage points higher among residents with ADRD reporting pain.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>Antiepileptic prescribing among nursing home residents with ADRD is increasing, while antipsychotic and opioid prescribing is declining. Examining antiepileptic prescribing to residents with ADRD who had disruptive behaviors and/or reported pain suggests that two of the most common antiepileptics, valproic acid and gabapentin, are being used in clinically distinct ways. Antiepileptic prescribing of questionable risk–benefit for dementia care warrants further scrutiny.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":3.332204510175204,"endowment":3.332204510175204,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"36349528","pmcid":"PMC9870979","openalex_id":"https://openalex.org/W4308638537","authors":[],"funders":[{"funder_name":"National Institute on Aging","grant_id":"R01AG056407","title":null},{"funder_name":"National Institute on Drug Abuse","grant_id":"R01DA045705‐S2","title":null},{"funder_name":"NIDA NIH HHS","grant_id":"R01 DA045705","title":null},{"funder_name":"National Institutes of Health","grant_id":"1R01DA045705-01","title":"Leveraging large-scale national data to understand, reduce, and prevent benzodiazepine-related harms among older adults"},{"funder_name":"National Institutes of Health","grant_id":"1R01AG056407-01A1","title":"Patient, Caregiver, and Regional Drivers of Potentially Inappropriate Medical Care for Dementia: Building the Foundation for State Dementia Policy"}],"total_grants":5,"fwci":3.3845,"citation_percentile":0.94030882,"influential_citations":0,"citation_trend":[{"year":2022,"count":1},{"year":2023,"count":6},{"year":2024,"count":12},{"year":2025,"count":5},{"year":2026,"count":3}],"oa_status":"bronze","license":"Wiley Online Library User Agreement","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jgs.18119","host_type":"journal"},{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jgs.18119","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/jgs.18119","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jgs.18119","host_type":"publisher"},{"url":"https://agsjournals.onlinelibrary.wiley.com/doi/pdf/10.1111/jgs.18119","host_type":"publisher"},{"url":"https://doi.org/10.1111/jgs.18119","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/36349528","host_type":"repository"},{"url":"https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/9870979","host_type":"repository"},{"url":"https://hdl.handle.net/2027.42/175795","host_type":"repository"},{"url":"https://doi.org/https://doi.org/10.1111/jgs.18119","host_type":""}],"fields_of_study":["Dementia and Cognitive Impairment Research","Pain Management and Opioid Use","Palliative Care and End-of-Life Issues","03 medical and health sciences","0302 clinical medicine","Aged","Humans","United States","Anticonvulsants","Analgesics, Opioid","Antipsychotic Agents","Valproic Acid","Gabapentin","Medicare","Practice Patterns, Physicians'","Nursing Homes","Alzheimer Disease","Pain"],"mesh_terms":["Gabapentin","Aged","Alzheimer Disease","Analgesics, Opioid","Anticonvulsants","Medicare","Humans","Nursing Homes","Pain","Practice Patterns, Physicians'","Antipsychotic Agents","United States","Valproic Acid"],"keywords":["Medicine","Medical prescription","Dementia","Gabapentin","Pharmacy","Minimum Data Set","Antipsychotic","Nursing homes","Population","Psychiatry","Family medicine","Gerontology","Disease","Nursing","Environmental health","Alternative medicine","Schizophrenia (object-oriented programming)","Internal medicine","Opioids","Antipsychotics","Antiepileptics","Valproic Acid","Pain","Medicare","United States","Analgesics, Opioid","Geriatrics","Alzheimer Disease","Health Sciences","Humans","Anticonvulsants","Practice Patterns, Physicians'","Aged","Antipsychotic Agents"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. 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