Background: Despite warnings and strict guidelines, the use of antipsychotics in long-term care facilities (LTCFs) remains problematic worldwide. Several factors, including facility and resident characteristics, could influence prescription practices. Given the vulnerability of the older people, this systematic review aims to analyze the key factors leading to variations in antipsychotic prescribing practices in LTCFs.
Method: Following PRISMA guidelines we searched PubMed, Scopus, CINAHL, and the Cochrane Library for primary research published between 2013 and 2023. Eligibility criteria included: population-LTCF residents aged 60 years or older with mental disorders; intervention-factors influencing variability in antipsychotic prescribing. The quality of the included studies was assessed using the JBI and STROBE checklists. Both data extraction and quality assessment were performed by two independent reviewers. Disagreements were resolved by consultation with a third reviewer.
Result: Of 6572 records, 6394 were screened by title and abstract, resulting in 14 studies included in our analysis. We found that better staff training and the availability of more registered and licensed nurses were associated with lower antipsychotic medication (APM) use. Nonprofit and government facilities exhibited lower APM prevalence and better quality of care.
Conclusion: Addressing facility factors and promoting collaboration between health professionals is crucial to reducing unnecessary antipsychotic use. This approach highlights that antipsychotic use is influenced by diverse prescribing cultures and healthcare environments, extending beyond the patient’s condition. Implementing guidelines and legislative actions can help reduce antipsychotic prescribing variation.
