3.12.2 Anti-Anxiety Medications

Medical Diagnosis of Anxiety

While anxiolytic medications are appropriate for managing medically diagnosed anxiety disorders, previous NFQR surveys have noted that these medications were administered to residents without a documented diagnosis of an anxiety disorder.

NFQR results indicate that in 2008, 16% of all residents had a documented diagnosis of an anxiety disorder. Compared to last year, nine percent more residents had a documented diagnosis of an anxiety disorder (Figure 3.12):

2004 — 17%
2005 — 12%
2006 — 7%
2007 — 7%
2008 — 16%

Proportion on Anti-Anxiety Medications

CMS data indicate that the proportion of residents on anti-anxiety medications in 2008 was 21%, an increase of one percent compared to last year (19) (Figure 3.12):

2007 — 20%
2008 — 21%

Reassessment of Anxiety Symptoms

NFQR data reveal that this year marked the highest proportion of residents who were reassessed every two weeks to evaluate anti-anxiety therapy goals. Of the residents diagnosed with an anxiety disorder this year (16%), 54% had an ongoing symptom assessment at least every two weeks to evaluate the stated, measurable goals of anti-anxiety therapy (Figure 3.12):

2004 — 45%
2005 — 23%
2006 — 6%
2007 — 19%
2008 — 54%

Of the residents diagnosed with anxiety, significantly more residents were assessed at least every two weeks for goals of anti-anxiety therapy this year than in the previous three years (20).

3.12.3 Sedative/Hypnotic (Sleep) Medications

Proportion of Residents who Reported Sleep Problems

Daytime sleepiness and nighttime sleep disturbances are common problems in residents of nursing facilities (Martin, 2006). In 2008, eight percent complained of sleep problems in the past 14 days. This proportion represents an increase of three percent more residents who complained of sleep problems this year compared to last year (Figure 3.12):

2004 — 8%
2005 — 9%
2006 — 6%
2007 — 5%
2008 — 8%

Proportion on Sleep Medications

Compared to 2004, significantly more residents were reported to be on sleep medications this year (21):

2004 — 11%
2005 — 16%
2006 — 13%
2007 — 13%
2008 — 15%

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Effectiveness of Sleep Medications

This year 28% of residents on a sleep medication reported continuing sleep problems (Figure 3.12):

2004 — 41%
2005 — 31%
2006 — 25%
2007 — 21%
2008 — 28%

Compared to 2004, significantly fewer residents reported continuing sleep problems this year (22). However, 28% indicates that more residents reported continuing sleep problems despite sleep medication this year compared to last year.

Figure 3.12 – Psychoactive Medications

Antipsychotics

Proportion of residents who received antipsychotic drugs — 30%

Accepted indication?

Of those who received an antipsychotic drug, how many had an accepted indication? 65%

Off-label use?

Of those who received an atypical antipsychotic drug, how many did not have a clinical indication? 33%

Medical diagnosis of anxiety? [Q11.1]

Of all residents, how many had a medical diagnosis of anxiety? 16%

Anxiolytics

Proportion of residents who received anxiolytic drugs — 21%

Regular reassessment? [Q11.1 and 11.4]

Of those diagnosed with anxiety, how many were reassessed at least every two weeks? 54%

Reported sleep problems? [Q12.1]

Of all residents, how many reported sleep problems? 8%

Sleep medications [Q12.3]

Proportion of residents on medications for sleep problems — 15%

Medication effective? [Q12.3 and 12.1]

Of residents on sleep medications, how many reported continued sleep problems? 28%

Survey conducted: February – July 2008 [Q#.#] = Survey question number (Appendix A) Survey sample: 2,129 from 128,971 residents (Medicare, Medicaid, or any other payer source) living in the 1,044 Medicaid certified nursing facilities in Texas. For further information, contact the NFQR Project Lead at 512-438-3472.

Footnotes

19. Note that the reported proportion of residents diagnosed with an anxiety disorder is independent of the reported proportion of residents on anti-anxiety medications. The proportion diagnosed with anxiety was calculated specifically on NFQR data. The proportion on anti-anxiety medications is based on self-reported CMS data from nursing facilities during different times each year. Since the data source, methodology, and sample population are different for the proportion diagnosed with an anxiety disorder and the proportion on anti-anxiety medications, inferences should not be drawn between the two proportions.

20. Statistically significant at p<.01.

21 Statistically significant at p<.01.

22 Statistically significant at p<.01.

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Updated: June 8, 2010