Psychotropic Medication Use and Mortality in Long-Term Care Residents

This chapter examines associations between psychotropic medications and mortality in long-term care home (LTCH) settings. We report new findings with census-level data from all new admissions to long-term care homes in the province of Ontario, Canada (i.e., 20,414 new residents). The data include three linked sets that indicate mortality during the financial years 2010–2011 and 2011–2012. One dataset, the Resident Assessment Instrument 2.0 (RAI 2.0), provides information on demographics, functional capability, clinical conditions, clinical diagnoses, mortality risk, and psychotropic medications. The latter include antipsychotics, antidepressants, analgesics, anxiolytics, and hypnotics. Administration of the RAI 2.0 occurs at resident intake, at quarterly intervals and annually. New analyses reported here examine predictors of daily and pro re nata (i.e., PRN or “as needed”) prescriptions of psychotropic medications. However, the most important analyses concern predictors of mortality within intervals of up to 90 days from the final RAI 2.0 assessment. After control for confounding variables, the findings indicate (1) attenuated mortality with daily prescription of frequently prescribed psychotropics (i.e., antipsychotics, antidepressants, and analgesics), (2) augmented mortality with PRN prescriptions for each type of psychotropic medication, and (3) evidence that PRN prescribing overturns beneficial effects of daily prescriptions, whereas the latter reduces the deleterious effects of PRN prescribing