Antidepressants in nursing homes for dependent older patients: the cross-sectional associations of institutional factors with prescription conformance

Key summary points Aim To determine the proportion of non-conforming antidepressant prescriptions among nursing home residents and identify the associated institutional and demographic factors. Findings Despite the practice guidelines, non-conforming antidepressant prescribing is still of significant concern in nursing homes, in over one-third of the residents. Institutional factors, such as simple drug prescribing actions and accessible psychiatric care, are associated with better antidepressant conformance and should be taken into account in further research. Message A “quality process” by the nursing home might optimize antidepressant prescribing for residents. Purpose Depression is diagnosed in approximately 40% of the nursing home (NH) residents, but the pertinence of the high use of antidepressants is often criticized. We aimed at determining the proportion of non-conforming antidepressant prescriptions among NH residents and the associated institutional and demographic factors. Methods Cross-sectional study of 2651 residents in 175 French NH participating in the IQUARE study (Impact of a QUAlity process on the development of practices and the functional decline of NH REsidents) and treated with antidepressants. Diagnosis of depression was obtained from the medical records. Antidepressant treatments were identified on the prescriptions and their conformance was analyzed in light of the international practice guidelines (i.e., indication, drug class, duplication, and monitoring). Results A total of 1017 residents (38.4%) had a non-conforming prescription. Availability of a list of recommended medications for older patients (OR = 1.39, 95% CI [1.15; 1.68], p