Bipolar Disorder in Nursing Homes: Impact on Antipsychotic Use, Diagnosis Patterns, and New Diagnoses in People with Dementia

TitleBipolar Disorder in Nursing Homes: Impact on Antipsychotic Use, Diagnosis Patterns, and New Diagnoses in People with Dementia
Publication TypeJournal Article
Year of Publication2018
AuthorsCarnahan R.M, Letuchy E.M
JournalAm J Geriatr Psychiatry
Volume26
Issue1
Pagination2-10
Date PublishedJan
ISBN Number1064-7481
Accession Number29031571
Keywords*antipsychotics, *Bipolar disorder, *dementia, *late onset bipolar disorder, *Nursing Homes, *quality measures, Aged, Antipsychotic Agents/*therapeutic use, Bipolar Disorder/*diagnosis/*drug therapy/epidemiology, Cross-Sectional Studies, Dementia/*diagnosis/epidemiology, Female, Humans, Iowa, Long-Term Care/statistics & numerical data, Male, Medicare/*statistics & numerical data, Nursing Homes/*statistics & numerical data, Quality Assurance, Health Care/*statistics & numerical data, Quality Indicators, Health Care/*statistics & numerical data, Time Factors, United States
Abstract

OBJECTIVES: Nursing home quality measures include the proportion of residents who receive antipsychotics. Residents with bipolar disorder are included even though antipsychotics are FDA-approved for this indication. We evaluated how including residents with bipolar disorder impacted the antipsychotic use quality measure for long-stay residents. We evaluated the agreement of minimum data set (MDS) bipolar disorder diagnoses with Medicare data, whether dementia was diagnosed before bipolar disorder, and how less-specific bipolar disorder diagnoses impacted findings. DESIGN: Cross-sectional study. SETTING: Nursing homes in Iowa. PARTICIPANTS: 21,955 long-stay nursing home residents in the first quarter of 2014. MEASUREMENTS: We identified antipsychotic use and bipolar disorder using MDS data. We compared MDS bipolar disorder diagnoses with Chronic Conditions Warehouse (CCW) "ever" bipolar disorder indicators, and prior year claims. We compared CCW condition onset dates to identify bipolar disorder diagnosed after dementia. RESULTS: The mean (SD) proportion receiving antipsychotics was 19.6% (11.1%) with bipolar disorder and 18.3% (10.8%) without. The positive predictive value (PPV) of MDS bipolar disorder diagnoses was 80.2% versus CCW lifetime indicators, and 74.6% versus claims. PPV decreased by 27.1% when "bipolar disorder, unspecified" and "other bipolar disorders" diagnoses were excluded. Nearly three-quarters of residents with bipolar disorder had dementia. Over half of those with dementia had dementia first per CCW records. This proportion was lower among those with more specific bipolar disorder diagnoses or MDS bipolar disorder indicators. CONCLUSIONS: Bipolar disorder in nursing home residents is often first diagnosed after dementia using nonspecific diagnoses. This practice deserves further evaluation.

URLhttps://www.ncbi.nlm.nih.gov/pubmed/29031571
DOI10.1016/j.jagp.2017.09.007
Short TitleThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric PsychiatryThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
Alternate JournalThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry