Center for Excellence in Assisted Living CEAL@UNC

Advancing the well-being of the people who live and work in assisted living through research, practice, and policy.

Medication

Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living

Jun 1, 2023
Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are […]

Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living

by Lea Efird-Green

Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are […]

Medication Costs and Use of Older Americans in Assisted Living Settings: A Nationally Representative Cross-Sectional Study

Feb 1, 2023
Background Assisted-living (AL) settings are an important residential care option for old and disabled Americans, but there are no national data characterizing medication use in AL. Objective To investigate medication costs and use of older adults living in the AL settings compared to those in the community, independent living, and nursing home settings. Design 2015 […]

Medication Costs and Use of Older Americans in Assisted Living Settings: A Nationally Representative Cross-Sectional Study

by Lea Efird-Green

Background Assisted-living (AL) settings are an important residential care option for old and disabled Americans, but there are no national data characterizing medication use in AL. Objective To investigate medication costs and use of older adults living in the AL settings compared to those in the community, independent living, and nursing home settings. Design 2015 […]

Psychotropic Medication Prescribing in Assisted Living and Nursing Home Residents with Dementia after the National Partnership

Dec 1, 2022
BackgroundThe Centers for Medicare & Medicaid Services implemented the National Partnership to Improve Dementia Care in Nursing Homes (the Partnership) to decrease antipsychotic use and improve care for nursing home (NH) residents with dementia. We determined whether the extent of antipsychotic and other psychotropic medication prescribing in AL residents with dementia mirrored that of long-stay […]

Psychotropic Medication Prescribing in Assisted Living and Nursing Home Residents with Dementia after the National Partnership

by Lea Efird-Green

BackgroundThe Centers for Medicare & Medicaid Services implemented the National Partnership to Improve Dementia Care in Nursing Homes (the Partnership) to decrease antipsychotic use and improve care for nursing home (NH) residents with dementia. We determined whether the extent of antipsychotic and other psychotropic medication prescribing in AL residents with dementia mirrored that of long-stay […]

Staff Attitudes Related to Antipsychotic Prescribing in Assisted Living

Sep 1, 2022
Assisted living (AL) provides the majority of residential long-term care in the United States. Almost 40% of AL residents display behaviors such as aggression and refusing care, 57% of whom receive medications for these behaviors. In nursing homes, concerns about inappropriate antipsychotic prescribing led to initiatives to reduce prescribing, and although there has been concern […]

Staff Attitudes Related to Antipsychotic Prescribing in Assisted Living

by Lea Efird-Green

Assisted living (AL) provides the majority of residential long-term care in the United States. Almost 40% of AL residents display behaviors such as aggression and refusing care, 57% of whom receive medications for these behaviors. In nursing homes, concerns about inappropriate antipsychotic prescribing led to initiatives to reduce prescribing, and although there has been concern […]

Beyond the Medication Pass: Attitudes, Ethics, Agency, and Antipsychotic Medications in Assisted Living/Residential Care

Aug 1, 2022
Background and Objectives As-needed (PRN) antipsychotic medication use (APU) among assisted living/residential care (AL/RC) residents is a controversial health policy issue. AL/RC care staff, families, clinicians, researchers, and policymakers disagree about PRN APU to manage behavioral expressions associated with residents’ dementia or cognitive impairment. Research Design and Methods Semistructured interviews among eleven direct care staff […]

Beyond the Medication Pass: Attitudes, Ethics, Agency, and Antipsychotic Medications in Assisted Living/Residential Care

by Lea Efird-Green

Background and Objectives As-needed (PRN) antipsychotic medication use (APU) among assisted living/residential care (AL/RC) residents is a controversial health policy issue. AL/RC care staff, families, clinicians, researchers, and policymakers disagree about PRN APU to manage behavioral expressions associated with residents’ dementia or cognitive impairment. Research Design and Methods Semistructured interviews among eleven direct care staff […]

Melatonin Prescribing in Assisted Living

Jun 1, 2022
Objectives: Aging is associated with sleep problems, which are common among assisted living (AL) residents. More than 40% of residents have insomnia, and almost 70% have a sleep disturbance of some kind. Melatonin to treat sleep disorders has become common among older adults, but its use in AL is unknown, which is concerning because melatonin […]

Melatonin Prescribing in Assisted Living

by Lea Efird-Green

Objectives: Aging is associated with sleep problems, which are common among assisted living (AL) residents. More than 40% of residents have insomnia, and almost 70% have a sleep disturbance of some kind. Melatonin to treat sleep disorders has become common among older adults, but its use in AL is unknown, which is concerning because melatonin […]

As-Needed Prescribing and Administration of Psychotropic Medications in Assisted Living: A 7-State Study

Jun 1, 2022
Objectives Psychotropic medications administered on an as-needed basis, often designated as pro re nata (or PRN, hereafter as-needed), can alleviate acute symptoms and facilitate deprescribing, although as-needed use is associated with negative outcomes such as polypharmacy and drug interactions. The aim of this study was to examine the extent to which PRN psychotropic medications are […]

As-Needed Prescribing and Administration of Psychotropic Medications in Assisted Living: A 7-State Study

by Lea Efird-Green

Objectives Psychotropic medications administered on an as-needed basis, often designated as pro re nata (or PRN, hereafter as-needed), can alleviate acute symptoms and facilitate deprescribing, although as-needed use is associated with negative outcomes such as polypharmacy and drug interactions. The aim of this study was to examine the extent to which PRN psychotropic medications are […]

Antibiotic Deescalation Opportunities for Residents in Assisted Living Facilities

Jun 1, 2022
Antibiotic prescribing patterns offer insights into clinical care across different health care settings, especially in nursing homes (NHs). These residents are highly susceptible to infection and are frequently inappropriately treated with antibiotics. Overuse and misuse of antibiotics is a common cause of adverse drug events, colonization, and infections caused by multidrug-resistant bacteria and Clostridioides difficile […]

Antibiotic Deescalation Opportunities for Residents in Assisted Living Facilities

by Lea Efird-Green

Antibiotic prescribing patterns offer insights into clinical care across different health care settings, especially in nursing homes (NHs). These residents are highly susceptible to infection and are frequently inappropriately treated with antibiotics. Overuse and misuse of antibiotics is a common cause of adverse drug events, colonization, and infections caused by multidrug-resistant bacteria and Clostridioides difficile […]

Impact of Function-Focused Care on Psychotropic Medications and Opioid Use among Assisted Living Residents

Mar 1, 2022
Objective: To test the impact of the Function Focused Care Intervention on use of psychotropic medications and opioids over a 12-month period in assisted living residents. Setting: The study included 794 residents from 85 general assisted living communities in the United States. The general assisted living communities that had at least 25 beds and 10 […]

Impact of Function-Focused Care on Psychotropic Medications and Opioid Use among Assisted Living Residents

by Lea Efird-Green

Objective: To test the impact of the Function Focused Care Intervention on use of psychotropic medications and opioids over a 12-month period in assisted living residents. Setting: The study included 794 residents from 85 general assisted living communities in the United States. The general assisted living communities that had at least 25 beds and 10 […]

Potential Side Effects and Adverse Events of Antipsychotic Use for Residents With Dementia in Assisted Living: Implications for Prescribers, Staff, and Families

Mar 1, 2022
Antipsychotic medications are frequently prescribed to assisted living (AL) residents who have dementia, although there is a lack of information about the potential side effects and adverse events of these medications among this population. Oversight and monitoring by family members is an important component of AL care, and it is important to understand family awareness […]

Potential Side Effects and Adverse Events of Antipsychotic Use for Residents With Dementia in Assisted Living: Implications for Prescribers, Staff, and Families

by Lea Efird-Green

Antipsychotic medications are frequently prescribed to assisted living (AL) residents who have dementia, although there is a lack of information about the potential side effects and adverse events of these medications among this population. Oversight and monitoring by family members is an important component of AL care, and it is important to understand family awareness […]