Variation and correlation of potential unintended consequences of antipsychotic reduction in Ontario nursing homes over time
Daniel A. Harris, MPH, Laura C. Maclagan, MSc, Priscila Pequeno, MSc, Andrea Iaboni, MD, DPhil, Peter C. Austin, PhD, Laura C. Rosella, PhD, Jun Guan, MSc, Colleen J. Maxwell, PhD, Susan E. Bronskill, PhD
Supplemental Table 3. Baseline characteristics of nursing homes in Ontario, Canada stratified by quintile of time trend for antidepressant use between April 1, 2010 and December 31, 2019 estimated from a multivariate model (N=649)
Characteristics Quintile 1
(n=129) Quintile 2
(n=130) Quintile 3
(n=130) Quintile 4
(n=130) Quintile 5
(n=130) Time trend (log-odds)1 of
antidepressant use, median (IQR)
-0.007
(-0.013, -0.004) 0.001
(-0.001, 0.002) 0.006
(0.005, 0.008) 0.013
(0.011, 0.014) 0.023 (0.020, 0.027) Facility characteristics
Number of beds, median (IQR) 96 (60-158) 123 (70-161) 129 (85-174) 125 (80-168) 90 (61-128) Neighborhood income quintile, n (%)
1 (lowest) 33 (25.6) 39 (30.0) 43 (33.1) 37 (28.5) 32 (24.6)
2 30 (23.3) 28 (21.5) 25 (19.2) 23 (17.7) 29 (22.3)
3 20 (15.5) 17 (13.1) 18 (13.9) 28 (21.5) 33 (25.4)
4 19 (14.7) 24 (18.5) 33 (25.4) 25 (19.2) 21 (16.2)
5 (highest) 27 (20.9) 22 (16.9) 11 (8.5) 17 (13.1) 14 (10.8)
Geographic location, n (%)
Urban 97 (75.2) 109 (83.9) 108 (83.1) 101 (77.7) 90 (69.2)
Rural 32 (24.8) 21 (16.2) 22 (16.9) 29 (22.3) 40 (30.8)
Resident composition, median (IQR) % Age, years
66-74 9.6% (6.6-13.6) 8.5% (6.0-11.9) 9.5% (6.6-12.3) 9.8% (6.7-13.4) 9.6% (6.7-13.6)
75-84 34.6% (28.2-40.3) 33.9% (29.8-39.0) 33.3% (29.5-37.4) 34.6% (31.1-38.5) 33.7% (30.0-38.5) 85+ 54.4% (49.4-63.2) 57.0% (50.3-63.3) 57.2% (51.6-61.3) 54.2% (48.8-60.3) 55.5% (48.6-63.1) Female 71.7% (66.7-76.9) 72.8% (67.8-76.1) 72.7% (69.0-78.0) 71.5% (67.5-75.8) 71.6% (66.7-76.7) Aggressive behavior scale
0: None 56.8% (45.7-66.7) 57.4% (46.8-64.8) 55.2% (46.4-64.6) 58.2% (47.9-66.9) 56.9% (45.1-66.2) 1-2: Mild to moderate 18.2% (14.7-22.7) 17.9% (14.2-24.6) 19.7% (14.9-24.5) 18.7% (13.4-22.5) 17.9% (15.1-23.5)
1
3-5: Severe 14.8% (11.0-21.8) 16.2% (11.5-21.3) 17.2% (12.0-22.4) 14.3% (10.5-20.5) 15.5% (11.4-23.2) 6+: Very severe 7.0% (3.7-12.9) 7.0% (4.4-11.3) 7.2% (3.7-11.5) 6.9% (3.2-11.5) 6.7% (3.3-10.8) Cognitive performance scale
0-1: Cognitively intact 26.3% (18.3-36.0) 25.0% (19.8-31.7) 25.6% (20.0-32.4) 26.5% (19.7-36.4) 26.2% (20.4-33.0) 2-4: Mild to moderate
cognitive impairment 50.8% (42.0-58.3) 51.2% (42.9-59.7) 50.6% (44.7-58.0) 50.2% (42.8-57.4) 49.4% (40.7-56.6) 5+: Severe to very severe
cognitive impairment 20.8% (15.1-27.5) 21.3% (16.7-28.4) 21.5% (16.7-28.6) 20.3% (15.2-26.8) 22.8% (15.1-29.1) Depression 28.7% (21.3-36.5) 29.2% (21.8-36.9) 29.8% (20.7-36.1) 26.4% (21.0-33.8) 25.8% (18.9-32.0) Dementia 61.3% (50.0-67.1) 60.8% (52.6-67.0) 59.9% (54.5-65.6) 58.2% (52.2-65.4) 58.7% (47.9-66.7)
Delusions 1.5% (0.0-3.9) 1.6% (0.5-3.8) 1.6% (0.0-3.5) 0.9% (0.0-3.1) 1.3% (0.0-3.5)
Schizophrenia 2.1% (0.8-3.4) 1.8% (0.6-3.4) 1.8% (1.0-3.7) 2.4% (1.0-4.1) 1.9% (0.0-3.8)
Relevant indications3 4.9% (3.0-8.6) 5.1% (3.3-8.3) 5.0% (3.1-7.8) 5.3% (2.7-8.0) 4.7% (3.0-8.5) Medications, median % (IQR %)
Overall antipsychotic use 31.0% (25.5-36.2) 29.7% (25.5-37.1) 30.5% (26.1-35.7) 31.1% (26.4-36.1) 32.0% (25.8-38.7) Potentially inappropriate
antipsychotic use2
25.9% (20.8-31.3) 25.5% (22.9-31.8) 26.7% (21.1-31.5) 27.2% (22.6-32.9) 27.9% (21.3-34.0) Antidepressant use 58.6% (52.9-67.7) 54.8% (48.9-62.7) 53.1% (46.3-61.0) 50.9% (44.6-57.1) 50.5% (44.4-56.9) Time trends (log-odds), median (IQR)
Potentially inappropriate antipsychotic use2
-0.021 (-0.037, -0.009)
-0.025 (-0.037, -0.014)
-0.024 (-0.036, -0.012)
-0.020 (-0.030, -0.008)
-0.023 (-0.036, -0.011)
Relevant indications3 0.022
(-0.005, 0.052) 0.026
(0.005, 0.055) 0.025
(0.002, 0.050) 0.022
(0.002, 0.050) 0.032 (0.006, 0.063) Notes: IRQ=interquartile range; “Baseline” represents when nursing homes were first represented in the dataset. For a majority of nursing homes (94%), this is 2010Q1; however, some nursing homes opened during the 10-year study period and thus have a different (baseline) starting quarter.
1) Time trends reflect facility-specific changes over time estimated from a multivariate model with random intercepts and slopes for time.
2) Potentially inappropriate antipsychotic use was estimated by dividing the number of residents receiving at least one antipsychotic without
delusions, hallucinations, schizophrenia, or Huntington’s disease indicated in their nursing home assessment by the total number of residents in the nursing home within a given quarter.
3) Relevant indications represent the diagnoses and symptoms used in a publicly reported quality indicator to define criteria for potentially inappropriate antipsychotic use: delusions, hallucinations, schizophrenia, and Huntington’s disease.