(P-063) Trends in Antipsychotic Dispensation to Residents of Long-term Care Facilities in Nova Scotia, Canada Including After a Fall-related Hospitalization

Background: Antipsychotic medications are commonly prescribed to residents of long-term care facilities (LTCF). Clinical practice guidelines recommend limiting antipsychotic use to short term in older adults due to risk of adverse events (e.g. falls, stroke and death).

Objectives: The objectives of the study were to describe the dispensing patterns of antipsychotic medications, and to assess predictors for continuation of an antipsychotic after a fall-related hospitalization in LTCF residents.

Methods: This was a retrospective cohort study of Nova Scotia Seniors Pharmacare Program Beneficiaries (NSSPB) aged 66 years and older, who resided in any of the province's 92 LTCF, and received at least one dispensation of an antipsychotic in any of the eight fiscal years from April 1, 2009 to March 31, 2017. Linked administrative claims data from the Seniors Pharmacare Program and the Canadian Institute of Health Information Discharge Abstract Database identified antipsychotic dispensation and fall-related hospitalizations. Dispensing patterns were reported as counts and proportions in a sex-stratified structure. Predictors for continuation of an antipsychotic after a fall-related hospitalization (sex, length of stay, days supplied, age, year of admission, rural/urban) were analyzed with univariate and multivariate logistic regression. Analysis was completed with SAS version 9.3.

Results: Over the period of study at least one antipsychotic medication was dispensed to 19,164 unique NSSPB. Residents of LTCF comprised 90% of those receiving at least one antipsychotic dispensation (N=17,201). A mean of 40% of NSSPB (mean N=2,637) residing in LTCF received at least one dispensation of an antipsychotic in each year studied. Second generation antipsychotics risperidone and quetiapine (mean 35.7% and 39.3% of total annual dispensations/year respectively) were dispensed most frequently. Women were dispensed significantly more antipsychotics at all ages than men, though the difference decreased significantly over time – 61% of dispensations were female in 2009, dropping to 58% in 2016 (p < 0.0001 for both rates).
Of the 544 NSSPB residing in LTCF who survived a fall-related hospitalization, 439 (80.7%) continued an antipsychotic upon hospital discharge. Decreased age was associated with continuing an antipsychotic after a fall-related hospitalization in multivariate analysis (OR 0.941, 95%CI [0.910-0.973]).

Conclusions: The prevalence of antipsychotic dispensation LTCF residents and continued dispensation after a fall-related hospitalization in Nova Scotia identifies an area needing intervention.