Medications for Depression, Psychosis Overused in VA Long-Term Care Facilities

Non-Pharmacologic Approaches Being Tested, More Data Gathered

By Annette M. Boyle

PITTSBURGH – Antidepressants and antipsychotic medications are being overused or prescribed inappropriately for residents of VA Community Living Centers (CLCs), according to recent research.

That problem is especially significant because so many CLC patients suffer from these conditions: One in three have been diagnosed with depression, while one-third have dementia. Furthermore, the issue is expected to become more complex as a large influx of aging baby boomers with even higher rates of dementia and substance-abuse disorders enter the VA’s long-term care and mental-health systems.

Bruce the Therapy Dog and Charles Filler, a resident at the VA Community Living Center in West Palm Beach, FL, get to know each other. Photo by Gary Dale

VA is both gathering evidence on how long-term care patients are currently being treated for dementia and depression and testing some nonpharmacologic solutions to the situation.

An analysis of records for 3,692 long-stay patients over the age of 65 admitted to 133 VA CLCs in 2004 and 2005 revealed that nearly 25% of these older patients had a diagnosis of depression. The study, published in the Journal of the American Geriatric Society, found almost twice as many patients received antidepressants, however, suggesting substantial overuse of the drugs.1

On the other hand, the study found that a quarter of patients with depression received no antidepressants. In addition, among depressed patients who received antidepressants, more than 40% had potential prescribing problems such as drug-drug and drug-disease interactions that could increase the potential for falls and cognitive impairment.

Treating depression appropriately is a growing concern for CLCs, as its prevalence has risen sharply among patients. A comparison of CLC residents admitted in 1998 and 2006 found that depression prevalence rose across all age groups and cohorts, from 27% to 37% overall. And, the prevalence is expected to continue to increase.

“The data suggest that those 55 to 64 years old, who make up the first cohort of baby boomers, have higher rates of depression, anxiety, and substance abuse compared with those now 65 to 74 years old,” noted Michele Karel, PhD, mental health program coordinator, Home-Based Primary Care at the VA Office of Mental Health Services, and colleagues in American Psychologist.2

As the leading edge of the “silver tsunami,” this group provides an indication of the challenges facing the VA as the number of Americans over the age of 65 rises from 40 million in 2010 to more than 72 million in 2030.

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