The Prevalence of Central Nervous System-Active Polypharmacy in US Nursing Homes

The American Geriatrics Society Beers Criteria strongly recommend that older adults avoid the concurrent use of ≥3 central nervous system-active (CNS) medications because of the increased risk of falls and fractures. We examined the prevalence of CNS polypharmacy and its associated factors in older adults living in US nursing homes.

Cross-sectional study.

Long-stay nursing home residents aged ≥65 years in US nursing homes with Fee-for-Service Medicare.

Using 2021 Minimum Data Set 3.0 linked with Medicare Part D claims data, long-stay residents with annual assessments were identified (n = 211,783). CNS polypharmacy was defined as the concurrent use of combination of ≥3 medications for >30 days of continuous exposure from the following drug classes: antidepressants, antiseizure medications, antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants. We estimated the point prevalence of CNS polypharmacy and described the number of distinct medications, drug classes, and drug class combinations. Modified Poisson models with robust error variance clustered by facility were fitted to examine characteristics associated with CNS polypharmacy compared with residents receiving no CNS medication.

CNS polypharmacy was common (23.2%). Among those with CNS polypharmacy, the most common drug class combination was 1 antidepressant, 1 antiseizure medication, and 1 antipsychotic (7.7%). Gabapentin was the most frequently prescribed agent involved with CNS polypharmacy. CNS polypharmacy was more prevalent among residents with psychiatric comorbidities (eg, depression, anxiety, bipolar disorder), pain, trouble sleeping, and a recent fall. Residents aged ≥85 years and those with severe cognitive impairment were less likely to be exposed to CNS polypharmacy.

CNS polypharmacy was common in US nursing homes, especially among residents with psychiatric comorbidity and in pain. These findings underscore the need for deprescribing strategies and nonpharmacologic interventions to mitigate risks associated with CNS polypharmacy.