# Antipsychotic reduction in nursing home residents with Alzheimer's disease: Impact on state, facility, and resident psychopharmacological medication use and outcomes

> **NIH NIH RF1** · UNIVERSITY OF MARYLAND BALTIMORE · 2021 · $97,247

## Abstract

In 2012, the National Partnership to Improve Dementia Care launched an initiative to reduce antipsychotic use
among nursing home residents with Alzheimer’s Disease and Related Dementias (ADRD). Within 5 years,
antipsychotic use decreased by 34.1% in all nursing home residents to a national prevalence of 15.7%. There
remain important unanswered questions surrounding outcomes of the antipsychotic reduction program (ARP),
including: which residents experienced reduced antipsychotic use; were residents who experienced
antipsychotic reductions switched to other psychopharmacological medications (PPM); and did medication
changes influence their health outcomes? The primary goal of this project is to conduct a series of analyses
using national administrative claims data linked to resident and nursing home survey data to assess the impact
of the ARP on state-, nursing home-, and individual- level antipsychotic and PPM (sedative-hypnotics, opioids,
antidepressants, anxiolytics, and anticonvulsants) utilization and health outcomes in the nursing home
population with ADRD. Our central hypothesis is that antipsychotic reductions resulted in unintended
consequences that exposed vulnerable nursing home residents to potentially harmful PPMs, leading to
downstream adverse health consequences. The proposed study utilizes a nationally-representative, 100%
sample of Medicare beneficiaries residing in long-stay nursing facilities from 2010–2016 that links prescription
and healthcare utilization claims data to nursing home- and nursing resident- level survey data. We will
accomplish the following specific aims: 1) To predict the impact of the ARP on antipsychotic and PPM use
patterns in nursing home residents, by state- and population- level characteristics; 2) To identify the impact of
the ARP on antipsychotic and PPM use patterns in nursing home residents, by facility-level characteristics; and
3) To test the prediction that ARP implementation affected critical individual-level public health outcomes (e.g.,
mortality, transitions in care settings, and falls/fractures) and patient-centered health outcomes (e.g., physical
restraint use, behavioral symptom emergence, functional status, pain) in nursing home residents with ADRD.
Using advanced methodological approaches, our multidisciplinary research team will assess state-, facility-,
and individual- level characteristics that may have mediated the impact of a sweeping policy that affected over
1.4 million nursing home residents. Our findings have the potential to guide health policy and program
refinement, and will add to our understanding of psychopharmacological medication use and their contribution
to health consequences in older adults with ADRD. Results will inform future studies that allow granular
examination of medication policies on other vulnerable nursing home subpopulations, such as racial minorities
and those with serious mental illness, chronic pain, and/or neurologic conditions. Findings will provide a...

## Key facts

- **NIH application ID:** 10318254
- **Project number:** 3RF1AG060939-01S1
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** LINDA J SIMONI-WASTILA
- **Activity code:** RF1 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $97,247
- **Award type:** 3
- **Project period:** 2019-03-01 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10318254

## Citation

> US National Institutes of Health, RePORTER application 10318254, Antipsychotic reduction in nursing home residents with Alzheimer's disease: Impact on state, facility, and resident psychopharmacological medication use and outcomes (3RF1AG060939-01S1). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10318254. Licensed CC0.

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