Incidence of Antiepileptic Drug Orders Among an Elderly Nursing Home Admission Cohort
Abstract number :
3.259
Submission category :
Year :
2000
Submission ID :
2492
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Nancy A Hardie, Judith Garrard, Susan L Harms, Cynthia R Gross, Patricia C Bland, Nicole M Nitz, Ilo E Leppik, Univ of Minnesota, Minneapolis, MN; Univ of, Minneapolis, MN; MINCEP, Minneapolis, MN.
RATIONALE: The purpose of this study was to estimate the post admission incidence of routine antiepiletic drug (AED) orders in a new admission cohort of elderly nurisng home residents followed up to 3 months from data entry. Factors associated with incident AED orders were also examined. METHODS: All elderly persons (? 65 years of age) admitted to Beverly Enterprises, Inc. nursing homes (a nationwide nursing home organization), January through March 1999, without an order for routine AED use were followed for up to 3 months to observe new orders for routine AEDs. Demographic, geographic, diagnostic and patient care factors were collected from admission Minimum Data Set (MDS) assessments. RESULTS: Data on residents fitting study critera (N=9,259) were obtained from 510 nursing homes located in 31 states. The crude incidence rate for AED use was 63.8 per 1,000 elderly nursing home admissions (95% CI: 58.8-68.8). Commonly used AEDs included lorazepam (3.%1), phenytoin (0.9%), valproic acid (0.8%) and gabapentin (0.7%). Overall incident AED use was statistically significantly (p < 0.05) related to the following main effects: diagnosis of epilepsy or seizure disorder (Odds Ratio (OR): 3.8; 95% CI: 1.8-8.3), anxiety disorder (OR: 4.5; 95% CI: 3.1-6.5), low score on the Cognitive Performance Scale (OR: 1.2; 95% CI: 1.0-1.3), Alzheimer's disease (OR: 1.5; 95% CI: 1.2-2.0), low score on the Activities of Daily Living Scale (OR: 1.03; 95% CI: 1.0-1.1) and less than a high school education (OR: 0.9; 95% CI: 0.8-.99). In the same analysis, 3 of 8 statistically significant (p < 0.05) interaction terms showed interaction with epilepsy/seizure disorder: less than a high school education (OR: 1.5; 95% CI: 1.1-2.0), congestive heart failure (OR: 0.43; 95% CI: 0.19-0.96) and anxiety disorder (OR: 0.21; 95% CI: 0.07-0.62). CONCLUSIONS: A surprisingly large number (6.4%) of elderly persons not receiving AEDs upon entry were prescribed these drugs within three months of admission, suggesting onset of new conditions requiring treatment. The specific nature of these conditions need to be investigated further to develop strategies for management. Supported by NINDS P50-NS16308.