Nursing homes in underserved areas with insufficient staff are more likely to give their residents antipsychotic drugs, a new study from researchers at NYU’s nursing and medical schools has found.
The research results, released Wednesday, make the first connection between homes’ location and medication prevalence. The study shows that understaffed nursing homes in severely disadvantaged neighborhoods across the country gave 19% of their residents antipsychotic medications, compared to 17% of residents in homes in in less-deprived neighborhoods.
Researchers assessed usage for residents that didn’t have a diagnosis of schizophrenia, Tourette syndrome or Huntington’s disease. They defined severely disadvantaged communities as those that have an area deprivation score, or a measure of socioeconomic disadvantages that can influence health care outcomes, of 85 or higher on a 100-point scale. “Understaffed” facilities were defined as those where residents received less than three hours of nursing care per day.
Throughout New York, nursing homes give antipsychotic medications to about one fifth of their residents to treat behavioral and physical aspects of dementia, including agitation and aggression. However, antipsychotics can be used inappropriately and have side effects that can increase mortality and morbidity risks among vulnerable patients.
New York’s long-term care sector is expected to grow into a $51 billion industry by 2030 according to Verified Market Research and Gov. Kathy Hochul’s final fiscal 2025 budget restores about $300 million in Medicaid funding to nursing homes and assisted living facilities.
According to NYU, residents in underserved neighborhoods might experience environmental factors that contribute to worse mental and physical health, such as less green space, higher crime rates and greater noise pollution. Worse health could contribute to greater use of antipsychotics.
The study found that when staffing levels improved, use of the medications decreased. Facilities in underserved areas that gave patients between three and 4.1 hours of care per day used antipsychotics for 15% of patients; homes in more affluent areas with the same staffing levels gave the drugs to 14% of residents. In nursing homes that provided “sufficient” staffing, or more than 4.1 hours per day, deprivation did not significantly influence antipsychotic usage.
“This means that staffing really made a difference in that inappropriate antipsychotic medication use,” said Jasmine Travers, an assistant professor at the NYU Rory Meyers College of Nursing and senior author of the study. She added that having more staff helps facilities find non-medication solutions for residents experiencing distress, such as taking them for walks or learning what triggers agitation for each individual.
However, she said, it’s a challenge for many facilities to reach sufficient staffing levels–one that could be made harder by a new federal staffing mandate that will require residents to receive more hours of care each day. The New York nursing home industry has met the mandate with pushback, and Travers added that its success will depend on whether enough federal funding is allocated to help homes make more hires, raise wages and provide more training.
The NYU researchers, from both Rory Meyers and the Grossman School of Medicine, studied more than 10,000 nursing homes around the U.S. including more than 1,800 in severely disadvantaged communities. Both schools are based in Kips Bay; the researchers also worked with a colleague from the University of Maryland School of Medicine. Their project was supported by a grant from the National Institute on Aging.
Jacqueline Neber , 2024-04-25 11:33:07
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