Psychotropic Drug Use in a Nursing Home: A 6-Year Retrospective

Abstract

The Omnibus Budget Reconciliation Act of 1987 (OBRA) was a public policy initiative intended to improve nursing home residents’quality of life by providing strict guidelines for the prescription of psychotropic drugs (PD) and physical restraints. This study documents and explains the use of PDs in one nursing home at three points in time: well before (1988), immediately before (1990), and well after (1994) OBRA implementation. In 1994, 64.5% of residents in the nursing home had prescriptions for PDs compared with 71% in 1988 and 1990, but those with a PD prescription had more than one (mean = 2.19). After OBRA implementation, antipsychotic and antidepressant use was higher than at earlier data collection points, whereas anti-anxiety medication prescription was at its lowest. In addition, diagnoses of depression and cognitive impairment had increased dramatically by 1994. Explanations for these findings are provided, including possible aging of residents, change in staffing levels, caregiver anomie, the impact of another legislative bill, and the introduction of the minimum data set.