(A-160) Antidepressant Use Among US Nursing Home Residents with ADRD in 2018

Background: Alzheimer’s disease and related dementias (ADRD) affect 6.7 million Americans, with nursing homes (NHs) as an important care setting. Antidepressants are the most prescribed psychotropics for NH residents with ADRD, yet little is known about the prescribing patterns, potential indications, and associated resident and NH characteristics.

Objectives: This study examined antidepressant use among long-stay NH residents with ADRD in 2018, described usage by class and type, and compared user vs. non-user characteristics overall and by potential indications (depressive/anxiety disorders, chronic pain, insomnia).

Methods: After linking 2018 data from the Minimum Data Set (MDS) 3.0 and Medicare claims, this cross-sectional study analyzed long-stay NH residents aged ≥ 65 with ADRD who were continuously enrolled in Medicare fee-for-service for 120 days before their annual MDS assessment (index date). Antidepressant use was defined as at least one claim for any antidepressants where the days of supply covered the index date. Descriptive analyses summarized resident characteristics, stratified by antidepressant use and potential indications. Modified Poisson regression with robust standard errors estimated adjusted prevalence ratios (aPRs) for associations with resident and NH characteristics.

Results: Among 280,283 residents with ADRD, 51.6% were prescribed antidepressants. Less than 5% of all residents had moderate to severe depression symptoms (PHQ-9 score ≥ 10). Antidepressant use was highest among residents with depressive or anxiety disorders (69.5%), followed by chronic pain (61.9%) and insomnia (60.0%). Among residents with none of these conditions, 14.1% received antidepressants. Trazodone and mirtazapine use was more common. Selective serotonin reuptake inhibitors were the most prescribed class overall (60.7%), with citalopram, mirtazapine, sertraline, and trazodone being the most frequently prescribed drugs. Non-Hispanic Black (aPR=0.84, 95% CI: 0.83–0.85), Hispanic (aPR=0.93, 95% CI: 0.91–0.94), and Asian residents (aPR=0.90, 95% CI: 0.87–0.93) were less likely to receive antidepressants compared to non-Hispanic White residents. Polypharmacy was strongly associated with antidepressant use (5–9 medications vs. < 5 medications: aPR=1.76, 95% CI: 1.74–1.80; 10+ medications vs. < 5 medications: aPR=1.81, 95% CI: 1.79–1.84), while diabetes, heart failure and stroke were associated with lower use.

Conclusions: We found widespread antidepressant use, extensive polypharmacy, and variation in antidepressant types used by indication. Outcomes research on the risks and benefits of antidepressant use in NHs is needed to inform prescribing and deprescribing recommendations for this widely used medication class in the NH.