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Cited by 397Pharmaceutical Practices and Patient OutcomesGeriatric Care and Nursing HomesDementia and Cognitive Impairment Research

A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes

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Avorn, Jerry, Soumerai, Stephen B., Everitt, Daniel E., Ross-Degnan, Dennis, Beers, Mark H., Sherman, David, Salem-Schatz, Susanne R., Fields, David·1992·New England Journal of Medicine
DOI 10.1056/nejm199207163270306
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Abstract

BACKGROUND: Although psychoactive medications have substantial side effects in the elderly, these drugs are used frequently in nursing homes. Few interventions have succeeded in changing this situation, and little is known about the clinical effects of such interventions. METHODS: We studied six matched pairs of nursing homes; at one randomly selected nursing home in each pair, physicians, nurses, and aides participated in an educational program in geriatric psychopharmacology. At base line we determined the type and quantity of drugs received by all residents (n = 823), and a blinded observer performed standardized clinical assessments of the residents who were taking psychoactive medications. After the five-month program, drug use and patient status were reassessed. RESULTS: Scores on an index of psychoactive-drug use, measuring both the magnitude and the probable inappropriateness of medication use, declined significantly more in the nursing homes in which the program was carried out (experimental nursing homes) than in the control nursing homes (decrease, 27 percent vs. 8 percent; P = 0.02). The use of antipsychotic drugs was discontinued in more residents in the experimental nursing homes than in the control nursing homes (32 percent vs. 14 percent); the comparable figures for the discontinuation of long-acting benzodiazepines were 20 percent vs. 9 percent, and for antihistamine hypnotics, 45 percent vs. 21 percent. In the experimental nursing homes residents who were initially taking antipsychotic drugs showed less deterioration on several measures of cognitive function than similar residents in the control facilities, but they were more likely to report depression. Those who were initially taking benzodiazepines or antihistamine hypnotic agents reported less anxiety than controls but had more loss of memory. Most other measures of clinical status remained unchanged in both groups. CONCLUSIONS: An educational program targeted to physicians, nurses, and aides can reduce the use of psychoactive drugs in nursing homes without adversely affecting the overall behavior and level of functioning of the residents.

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  • For the seven studies that received no control intervention, the pooled odds ratio was 1.36 (95% CI 0.92 to 1.99, P = 0.099).

    “Of these, seven were suitable for inclusion in a meta‐regression, and the pooled odds ratio for the seven studies that received no control intervention was 1.36 (95% CI 0.92 to 1.99, P value = 0.099) (Avorn 1992; Callahan 1994; Flottorp 2002; Looijmans 2010; Murphy 2009; Scott 2013; Schouten 2007).”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as Avorn 1992

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  1. [6]6. Erman MK, ed. Sleep disorders. Psychiatr Clin North Am 1987;10:517724.
  2. [11]11. Schaffner W, Ray WA, Federspiel CF. Chloramphenicol and tetracycline usage in outpatient practice. QRB Qual Rev Bull 1979;5:28-31.
  3. [16]16. Snedecor GW, Cochran WG. Statistical methods. 7th ed. Ames: Iowa State University Press, 1980.
  4. [19]19. Albert M, Moss M. The assessment of memory disorders in patients with Alzheimer disease. In: Squire LR, Butters N, eds. Neuropsychology of memory. New York: Guilford Press, 1984:236-46.
  5. [23]23. Hesbacher PT, Rickels K, Morris RJ, Newman H, Rosenfeld H. Psychiatric illness in family practice. J Clin Psychiatry 1980;41:6-10.

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Authors
Avorn, J., Soumerai, S. B., Everitt, D. E., Ross-Degnan, D., Beers, M. H., Sherman, D., Salem-Schatz, S. R., & Fields, D.
Affiliations
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1992-07-16
Volume
327
Issue
3
Pages
168-173
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199207163270306
OpenAlex
W2312742905
Cited by
397
References
23
Citations by year
2026: 2 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 6 · 2020: 9 · 2019: 5 · 2018: 13 · 2017: 6 · 2016: 14 · 2015: 11 · 2014: 13 · 2013: 7 · 2012: 14
FWCI
23.37
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
psychoactive substances, nursing homes, antipsychotic drugs, benzodiazepines, inappropriate medication use, employee training, cognitive function, depression, anxiety, memory loss, older adults
MeSH terms
Aged, Antidepressive Agents, Benzodiazepines, Drug Utilization, Education, Continuing, Education, Medical, Continuing, Education, Nursing, Continuing, Geriatric Psychiatry, Homes for the Aged, Humans, Hypnotics and Sedatives, Massachusetts, Mental Processes, Nursing Assistants, Nursing Homes, Psychotropic Drugs, Treatment Outcome

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