Central Nervous System Medication Use Among Older Adults in Korean Long-Term Care Facilities: A Multilevel Analysis

To analyze factors influencing central nervous system (CNS) medication use among older adults residing in long-term care (LTC) facilities in South Korea, considering both individual- and facility-level factors.

Cross-sectional study using nationwide claim data from the National Health Insurance Service.

The study included 134,718 adults aged 65 years and older who received outpatient prescriptions while residing in 4153 LTC facilities across South Korea in 2023.

Multilevel logistic regression analysis was conducted using generalized linear mixed-effects models to examine associations of individual- and facility-level variables with CNS medication use.

Among residents who received outpatient prescriptions, 86.2% had used CNS medications. Individual-level factors associated with higher CNS medication use included male sex [odds ratio (OR), 1.12; 95% CI, 1.07-1.17], lower income (OR, 1.56; 95% CI, 1.48-1.64), greater functional independence (OR, 2.88; 95% CI, 2.42-3.44), higher Charlson Comorbidity Index score (OR, 1.19; 95% CI, 1.13-1.24), longer facility residence (OR, 2.50; 95% CI, 2.41-2.60), and presence of dementia (OR, 1.93; 95% CI, 1.86-2.00). However, the oldest age group (≥90 years) showed lower odds of CNS medication use compared with those aged <80 years (OR, 0.80; 95% CI, 0.76-0.84). At the facility level, privately operated facilities had higher odds of CNS medication use compared with public facilities (OR, 1.37; 95% CI, 1.18-1.58).

The high prevalence of CNS medication use among prescription-receiving residents, particularly those with dementia and greater functional independence, raises concerns about medication appropriateness. Significant facility-level variations in prescribing patterns highlight the need for systematic medication monitoring and review in Korean LTC facilities.