Date of Award


Document Type


Degree Name

Medical Doctor (MD)

First Advisor

Paul Kirwin


Currently there are 1.6 million nursing home residents in the United States, a large number of which receive antidepressants, opioids and/or antipsychotics. Antipsychotics are typically used in nursing home patients to treat schizophrenia, bipolar disorder and psychosis associated with dementia. One study estimated antipsychotic use among nursing home residents at about 15% (8.5% atypical and 5.8% typical). [1] Conservative estimates of depression in cognitively intact nursing home residents ranges from 10-20%, and runs as high as 50-70% in cognitively impaired residents. [2] The true number of depressed nursing home patients is likely to be higher since even when recognized, depression is either not treated or sub-optimally treated. In one study of nursing home residents, only 50% of those diagnosed with depression were receiving treatment. [3] Similarly undertreated, persistent pain has been shown to be present in 49-89% of nursing home patients although only 38.4% of residents with persistent pain receive opioid analgesics according to data on nursing home residents in 10 states. [4] Although some have suggested that antipsychotics are over utilized while antidepressants and opioids are underutilized, it remains that a significant number of nursing home patients are routinely prescribed one or more of these NP drug classes.