Objective: To determine whether antipsychotic prescriptions differ between community-dwelling and nursing home residents with PD in the last 6 months of life.

Background: Most antipsychotics are considered potentially inappropriate medications in persons with Parkinson’s disease (PD). These anti-dopaminergic medications can worsen PD symptomology and increase mortality risk.

Method: This retrospective cohort study included United States (US) Medicare Part D beneficiaries aged 65 and older with PD who died between January 1, 2017, and December 31, 2017. Beneficiaries with drug-induced parkinsonism were excluded. Clinical characteristics were compared between community-dwelling and nursing home residents using descriptive statistics. Outpatient prescriptions for potentially inappropriate antipsychotics (chlorpromazine, fluphenazine, haloperidol, lurasidone, olanzapine, paliperidone, perphenazine, pimozide, risperidone, ziprasidone) and appropriate antipsychotics (aripiprazole, clozapine, quetiapine) were defined using the 2015 Beers Criteria. The proportion of unique individuals receiving inappropriate and appropriate antipsychotics in the last 6 months of life were compared between groups using chi-square analyses. Inpatient and hospice prescriptions were excluded.

Results: There were 40,594 Medicare Part D decedents with PD in 2017, of which 35,009 (86.2%) were prescribed at least 1 medication in their last 6 months of life, resulting in 1,306,738 total prescriptions. Of 19,170 community-dwelling residents, 4,059 (21.2%) had psychosis. Of 16,263 nursing home residents, 7,015 (43.1%) had psychosis. When comparing outpatient antipsychotic prescriptions, nursing home residents with PD and psychosis were more likely than community-dwelling residents with PD and psychosis to be prescribed at least 1 inappropriate antipsychotic (21.4% vs. 14.2%, p<0.001) in their last 6 months of life. Appropriate antipsychotic prescribing was similar between groups (24.8% vs. 23.2%, p=0.06).

Conclusion: Nursing home residents are more likely than community-dwelling residents with PD to be diagnosed with psychosis and prescribed potentially inappropriate antipsychotics in the last 6 months of life. These data may reflect poor prescribing practices in US nursing homes and warrants further investigation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/antipsychotic-prescriptions-among-nursing-home-residents-with-parkinsons-disease-in-the-end-of-life-period/