Antipsychotic Use in Nursing Homes: Geographic Variation and Off-Label Use

A research letter in the Journal of the American Medical Association provides updated information on the use of antipsychotic medications in nursing homes in the United States. The findings, based on data collected in 2009 and 2010 from a large long-term care pharmacy that serves about one-half of US nursing home residents, identify the proportion of residents in each state (excluding Alaska, Hawaii, and North Dakota, which lacked sufficient data) who were prescribed at least one antipsychotic drug.

States with the highest rates of antipsychotic use were located mainly in the central and southern continental US (where approximately 28 percent of residents were prescribed at least one antipsychotic drug), while the states with the lowest rates of antipsychotic use (closer to 17 percent) were mostly located in the west. Just 7.5 percent of residents included in the study received only one antipsychotic drug. The median number of prescriptions was 10, usually administered for a period of 30 to 77 days.

Overall, 22 percent of nursing home residents in the study were prescribed at least one antipsychotic drug during the observation period. This suggests that rates of antipsychotic use in nursing homes may be closer to the low end of earlier estimates. However, high geographic variation in prescribing and the high rate of off-label use for symptoms related to dementia suggest that there is no consistent, evidence-based approach to antipsychotic prescriptions in US nursing homes.


Briesacher BA, Tjia J, Field T, et al. Antipsychotic use among nursing home residents. Journal of the American Medical Association (2013); 309(5):440-442.

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