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The Prevalence and Factors Associated with Antiepileptic Drug Use in US Nursing Home Residents

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Abstract

Background

Antiepileptic drugs (AEDs) are commonly used by nursing home residents, both on- and off-label. The landscape of AED use has changed over the past two decades; however, despite this, contemporaneous research on AED use in US nursing home residents is scant.

Objective

The aim of this study was to estimate the prevalence of AED use, describe prescribing patterns, identify factors associated with AED use, and assess whether these factors differ among AEDs with expanded indications in older adults (i.e. gabapentin, pregabalin, topiramate, and lamotrigine).

Methods

We conducted a cross-sectional study among 549,240 long-stay older residents who enrolled in fee-for-service Medicare and lived in 15,111 US nursing homes on 1 September 2016. Demographics and conditions associated with AED indications, epilepsy comorbidities, and safety data came from the Minimum Data Set Version 3.0 (MDS 3.0). Medicare Part D claims were used to identify AED use. Robust Poisson models and multinomial logistic models for clustered data estimated adjusted prevalence ratios (aPR), adjusted odds ratios (aOR), and 95% confidence intervals (CIs).

Results

Overall, 24.0% used AEDs (gabapentin [13.3%], levetiracetam [4.7%], phenytoin [1.9%], pregabalin [1.8%], and lamotrigine [1.2%]). AED use was associated with epilepsy (aPR 3.73, 95% CI 3.69–3.77), bipolar disorder (aPR 1.20, 95% CI 1.18–1.22), pain (aPRmoderate/severe vs. no pain 1.42, 95% CI 1.40–1.44), diabetes (aPR 1.27, 95% CI 1.26–1.28), anxiety (aPR 1.12, 95% CI 1.11–1.13), depression (aPR 1.17, 95% CI 1.15–1.18), or stroke (aPR 1.08, 95% CI 1.06–1.09). Residents with advancing age (aPR85+ vs. 65–74 years 0.73, 95% CI 0.73–0.74), Alzheimer’s disease/dementia (aPR 0.87, 95% CI 0.86–0.88), or cognitive impairment (aPRsevere vs. no impairment 0.62, 95% CI 0.61–0.63) had decreased AED use. Gabapentinoid use was highly associated with pain (aORmoderate/severe vs. no pain 2.07, 95% CI 2.01–2.12) and diabetes (aOR 1.79, 95% CI 1.76–1.82), but not with an epilepsy indication.

Conclusions

AED use was common in nursing homes, with gabapentin most commonly used (presumably for pain). That multiple comorbidities were associated with AED use underscores the need for future studies to investigate the safety and effectiveness of AED use in nursing home residents.

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Author information

Authors and Affiliations

  1. Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA

    Danni Zhao, Divya Shridharmurthy, Matthew J. Alcusky, Yiyang Yuan, Anthony P. Nunes, Jonggyu Baek & Kate L. Lapane

  2. Department of Family Medicine, Alpert Medical School, Brown University, Memorial Hospital of Rhode Island, Providence, RI, 02903, USA

    Anne L. Hume

  3. Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, 02881, USA

    Anne L. Hume

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  1. Danni Zhao
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Contributions

DZ had full access to all data in the study and is responsible for the data integrity and accuracy of the data analysis. Study concept and design: DZ, DS, and KLL. Acquisition of data: KLL. Analysis and interpretation of data: DZ, YY, JB, KLL. Statistical analysis: DZ, KLL. Preparation of the manuscript: DZ, KLL. Critical revision of the manuscript for important intellectual content: DZ, MJA, APN, ALH, and KLL. Obtained funding: KLL. Study supervision: KLL. The final manuscript submitted for publication was read and approved by all authors.

Corresponding author

Correspondence to Danni Zhao.

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Funding

This study was funded by a grant from the National Institute for Nursing Research (R01NR016977; Principal Investigator: Kate L. Lapane).

Conflict of interest

Danni Zhao, Divya Shridharmurthy, Matthew J. Alcusky, Yiyang Yuan, Anthony P. Nunes, Anne L. Hume, Jonggyu Baek, and Kate L. Lapane declare they have no conflicts of interest.

Ethical approval

This study used a routinely collected administrative and claims dataset and was approved by the University of Massachusetts Medical School Institutional Review Board (protocol number H00011964).

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Zhao, D., Shridharmurthy, D., Alcusky, M.J. et al. The Prevalence and Factors Associated with Antiepileptic Drug Use in US Nursing Home Residents. Drugs Aging 37, 137–145 (2020). https://doi.org/10.1007/s40266-019-00732-2

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