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Among patients with ADRD receiving care from a home health agency, antipsychotic use was tied to less improvement in activities of daily living.

Antipsychotics are more often used by older adults receiving home health care (HHC) services with Alzheimer disease and related dementias (ADRD) versus those without ADRD, and their use is associated with worse functional outcomes, according to a study published online Sept. 6 in the Journal of the American Geriatrics Society.

Jinjiao Wang, Ph.D., R.N., from the University of Rochester in New York, and colleagues conducted a secondary analysis of 6,684 adults aged 65 years and older, with and without ADRD, receiving care from an HHC agency in 2019 to examine the prevalence and predictors of antipsychotic use and its impact on outcomes among those living with ADRD. The change in the composite activities of daily living (ADL) score from HHC admission to HHC discharge (functional outcome) was measured in 5,833 patients, where a positive score indicates improvement and a negative score indicates decline.

The researchers found that among patients with and without ADRD, the point prevalence of antipsychotic use was 17.2 and 6.6 percent, respectively. Predictors of antipsychotic use among patients living with ADRD included having greater ADL limitations, taking more medications, having behavioral and psychological symptoms, and living alone. Antipsychotic use was associated with having less ADL improvement at HHC discharge among patients living with ADRD.

“Antipsychotic use in persons with dementia is a serious patient safety issue, and it should be regularly reviewed for opportunities of deprescribing — such as dose reduction until discontinuation — whenever possible,” Wang said in a statement.

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