Table 1.
Resident characteristics (DAL vs. LTC), overall and in relation to antipsychotic use (row%)
| Characteristic n (%), unless otherwise noted | DAL residents | LTC residents | ||||
|---|---|---|---|---|---|---|
| Total sample (n = 1089) | Antipsychotic users (n = 287 [26.4%]) | Antipsychotic non-users (n = 802 [73.6%]) | Total sample (n = 1000) | Antipsychotic users (n = 318 [31.8%]) | Antipsychotic non-users (n = 682 [68.2%]) | |
| Sociodemographic | ||||||
| Age, years | ||||||
| Mean ± SD | 84.9 ± 7.3 | 84.2 ± 7.3 | 85.2 ± 7.3** | 84.9 ± 7.6 | 83.9 ± 7.5 | 85.4 ± 7.6* |
| 65–79 | 272 (25.0) | 84 (30.9) | 188 (69.1) | 231 (23.1) | 89 (38.5) | 142 (61.5)* |
| 80–85 | 285 (26.2) | 78 (27.4) | 207 (72.6) | 256 (25.6) | 83 (32.4) | 173 (67.6) |
| 86–89 | 247 (22.7) | 61 (24.7) | 186 (75.3) | 216 (21.6) | 68 (31.5) | 148 (68.5) |
| ≥90 | 285 (26.1) | 64 (22.5) | 221 (77.5) | 297 (29.7) | 78 (26.3) | 219 (73.7) |
| Sex | ||||||
| Male | 254 (23.3) | 66 (26.0) | 188 (74.0) | 343 (34.3) | 113 (32.9) | 230 (67.1) |
| Female | 835 (76.7) | 221 (26.5) | 614 (73.5) | 657 (65.7) | 205 (31.2) | 452 (68.8) |
| Facility length of stay, months | ||||||
| Mean ± SD | 23.0 ± 19.7 | 25.4 ± 21.9 | 22.1 ± 18.9* | 36.8 ± 39.2 | 36.1 ± 34.1 | 37.1 ± 41.4 |
| <12 | 377 (34.6) | 80 (21.2) | 297 (78.8)* | 264 (26.4) | 74 (28.0) | 190 (72.0) |
| 12–24 | 314 (28.8) | 86 (27.4) | 228 (72.6) | 222 (22.2) | 75 (33.8) | 147 (66.2) |
| >24 | 398 (36.6) | 121 (30.4) | 277 (69.6) | 514 (51.4) | 169 (32.9) | 345 (67.1) |
| Location prior to admission | ||||||
| Home | 409 (37.6) | 102 (24.9) | 307 (75.1) | 148 (14.8) | 49 (33.1) | 99 (66.9) |
| Hospital | 326 (29.9) | 90 (27.6) | 236 (72.4) | 445 (44.6) | 139 (31.2) | 306 (68.8) |
| Institution (AL/LTC/other) | 354 (32.5) | 95 (26.8) | 259 (73.2) | 404 (40.5) | 127 (31.4) | 277 (68.6) |
| Health and functional status | ||||||
| Dementia and treatment statusa | ||||||
| No dementia | 462 (42.4) | 62 (13.4) | 400 (86.6)* | 292 (29.2) | 53 (18.2) | 239 (81.8)* |
| Dementia, not treated | 361 (33.2) | 127 (35.2) | 234 (64.8) | 557 (55.7) | 197 (35.4) | 360 (64.6) |
| Dementia, treated | 266 (24.4) | 98 (36.8) | 168 (63.2) | 151 (15.1) | 68 (45.0) | 83 (55.0) |
| Psychiatric diagnosesb | ||||||
| No | 888 (81.5) | 202 (22.7) | 686 (77.3)* | 778 (77.8) | 206 (26.5) | 572 (73.5)* |
| Yes | 201 (18.5) | 85 (42.3) | 116 (57.7) | 222 (22.2) | 112 (50.5) | 110 (49.5) |
| Depression diagnosis | ||||||
| No | 715 (65.7) | 170 (23.8) | 545 (76.2)* | 563 (56.3) | 153 (27.2) | 410 (72.8)* |
| Yes | 374 (34.3) | 117 (31.3) | 257 (68.7) | 437 (43.7) | 165 (37.8) | 272 (62.2) |
| Depression symptoms (DRS score)c | ||||||
| No (<3) | 880 (80.8) | 199 (22.6) | 681 (77.4)* | 492 (49.3) | 124 (25.2) | 368 (74.8)* |
| Yes (≥3) | 209 (19.2) | 88 (42.1) | 121 (57.9) | 505 (50.7) | 194 (38.4) | 311 (61.6) |
| Delusions/hallucinations | ||||||
| No | 999 (91.7) | 241 (24.1) | 758 (75.9)* | 845 (84.5) | 233 (27.6) | 612 (72.4)* |
| Yes | 90 (8.3) | 46 (51.1) | 44 (48.9) | 155 (15.5) | 85 (54.8) | 70 (45.2) |
| Cardiovascular diseased | ||||||
| No | 284 (26.1) | 94 (33.1) | 190 (66.9)* | 238 (23.8) | 83 (34.9) | 155 (65.1) |
| Yes | 805 (73.9) | 193 (24.0) | 612 (76.0) | 762 (76.2) | 235 (30.8) | 527 (69.2) |
| Cerebrovascular diseasee | ||||||
| No | 823 (75.6) | 239 (29.0) | 584 (71.0)* | 687 (68.7) | 230 (33.5) | 457 (66.5)** |
| Yes | 266 (24.4) | 48 (18.0) | 218 (82.0) | 313 (31.3) | 88 (28.1) | 225 (71.9) |
| No. of co-morbidities | ||||||
| Mean ± SD | 4.6 ± 2.0 | 4.7 ± 2.2 | 4.6 ± 1.9 | 5.2 ± 2.0 | 5.3 ± 2.1 | 5.2 ± 2.0 |
| 0–3 | 333 (30.6) | 103 (30.9) | 230 (69.1)* | 202 (20.2) | 67 (33.2) | 135 (66.8) |
| 4 or 5 | 406 (37.3) | 88 (21.7) | 318 (78.3) | 379 (37.9) | 109 (28.8) | 270 (71.2) |
| ≥6 | 350 (32.1) | 96 (27.4) | 254 (72.6) | 419 (41.9) | 142 (33.9) | 277 (66.1) |
| No. of medicationsf | ||||||
| Mean ± SD | 8.0 ± 3.6 | 7.8 ± 3.5 | 8.1 ± 3.7 | 7.6 ± 3.6 | 7.7 ± 3.4 | 7.6 ± 3.7 |
| 0–6 | 391 (35.9) | 108 (27.6) | 283 (72.4) | 402 (40.2) | 131 (32.6) | 271 (67.4) |
| 7–8 | 242 (22.2) | 71 (29.3) | 171 (70.7) | 208 (20.8) | 61 (29.3) | 147 (70.7) |
| 9–10 | 207 (19.0) | 50 (24.2) | 157 (75.8) | 187 (18.7) | 63 (33.7) | 124 (66.3) |
| ≥11 | 249 (22.9) | 58 (23.3) | 191 (76.7) | 203 (20.3) | 63 (31.0) | 140 (69.0) |
| Antidepressants | ||||||
| No | 600 (55.1) | 121 (20.2) | 479 (79.8)* | 519 (51.9) | 122 (23.5) | 397 (76.5)* |
| Yes | 489 (44.9) | 166 (33.9) | 323 (66.1) | 481 (48.1) | 196 (40.7) | 285 (59.3) |
| Anxiolytics | ||||||
| No | 975 (89.5) | 252 (25.8) | 723 (74.2) | 897 (89.7) | 274 (30.5) | 623 (69.5)* |
| Yes | 114 (10.5) | 35 (30.7) | 79 (69.3) | 103 (10.3) | 44 (42.7) | 59 (57.3) |
| Sedatives/hypnotics | ||||||
| No | 844 (77.5) | 221 (26.2) | 623 (73.8) | 801 (80.1) | 242 (30.2) | 559 (69.8)* |
| Yes | 245 (22.5) | 66 (26.9) | 179 (73.1) | 199 (19.9) | 76 (38.2) | 123 (61.8) |
| FI | ||||||
| Robust (FI score <0.2) | 366 (33.6) | 66 (18.0) | 300 (82.0)* | 62 (6.2) | 14 (22.6) | 48 (77.4)* |
| Pre-frail (FI score 0.2–0.3) | 424 (38.9) | 99 (23.3) | 325 (76.7) | 197 (19.7) | 26 (13.2) | 171 (86.8) |
| Frail (FI score >0.3) | 299 (27.5) | 122 (40.8) | 177 (59.2) | 741 (74.1) | 278 (37.5) | 463 (62.5) |
| Falls | ||||||
| None | 780 (71.6) | 203 (26.0) | 577 (74.0) | 730 (73.0) | 217 (29.7) | 513 (70.3)* |
| ≥1 falls/90 days | 309 (28.4) | 84 (27.2) | 225 (72.8) | 270 (27.0) | 101 (37.4) | 169 (62.6) |
| Physical restraints | ||||||
| No | 1057 (97.1) | 278 (26.3) | 779 (73.7) | 594 (59.4) | 168 (28.3) | 426 (71.7)* |
| Yes | 32 (2.9) | 9 (28.1) | 23 (71.9) | 406 (40.6) | 150 (36.9) | 256 (63.1) |
| Any inpatient hospitalizations and/or ED visits (past 90 days) | ||||||
| None | 840 (77.1) | 229 (27.3) | 611 (72.7) | 899 (89.9) | 290 (32.3) | 609 (67.7) |
| ≥1 | 249 (22.9) | 58 (23.3) | 191 (76.7) | 101 (10.1) | 28 (27.7) | 73 (72.3) |
| Behavioral characteristics | ||||||
| Aggressive behavior (ABS Score)g | ||||||
| None (0) | 771 (70.8) | 156 (20.2) | 615 (79.8)* | 341 (34.1) | 63 (18.5) | 278 (81.5)* |
| Moderate (1–2) | 183 (16.8) | 63 (34.4) | 120 (65.6) | 203 (20.3) | 66 (32.5) | 137 (67.5) |
| Severe to very severe (≥3) | 135 (12.4) | 68 (50.4) | 67 (49.6) | 456 (45.6) | 189 (41.4) | 267 (58.6) |
| Elopement attempts or threats | ||||||
| No | 985 (90.4) | 234 (23.8) | 751 (76.2)* | 832 (83.2) | 230 (27.6) | 602 (72.4)* |
| Yes | 104 (9.6) | 53 (51.0) | 51 (49.0) | 168 (16.8) | 88 (52.4) | 80 (47.6) |
| Wandering | ||||||
| No | 967 (88.8) | 226 (23.4) | 741 (76.6)* | 770 (77.0) | 210 (27.3) | 560 (72.7)* |
| Yes | 122 (11.2) | 61 (50.0) | 61 (50.0) | 230 (23.0) | 108 (47.0) | 122 (53.0) |
ABS Aggressive Behavior Scale, AL assisted living, DAL designated assisted living, DRS Depression Rating Scale, ED emergency department, FI Frailty Index, LTC long-term care, SD standard deviation
* p < 0.05; ** p < 0.1
aDementia treatment defined as use of acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) or memantine
bPsychiatric diagnoses defined as a diagnosis of schizophrenia, bipolar disorder, or anxiety
cDRS, 3 LTC residents missing; n = 997
dCardiovascular diseases defined as diagnoses of hypertension, coronary heart disease, congestive heart failure, peripheral vascular disease, cardiac dysrhythmia, valvular stenosis, venous thromboembolism, or lipid abnormalities
eCerebrovascular diseases defined as history of stroke or diagnosis of cerebrovascular disease
fNumber of medications excludes antipsychotics
gABS: a summary scale of four behaviors (verbal abuse, physical abuse, socially inappropriate or disruptive, resists care), with higher scores indicating a greater number and frequency of behavioral issues