Date of Award

4-12-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Paul Kirwin

Abstract

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.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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