Epilepsy Drugs Common in Nursing Homes

Many placed on medications after admission

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By
HealthDay Reporter

MONDAY, May 5, 2003 (HealthDayNews) -- Do nursing home residents have more conditions that require antiepileptic drugs, or are these powerful medications being over-prescribed?

A new study raises this question after discovering that more than 10 percent of nursing home residents are taking these drugs even though only 5 percent or 6 percent suffer from epilepsy.

The findings, appearing in the May 5 issue of the Annals of Neurology, build on previous research showing that antiepileptic drug use is higher among nursing home residents than among seniors in the general population.

After examining medical records of 10,000 residents in 500 nursing homes nationwide, University of Minnesota researchers discovered this discrepancy -- a trend they say warrants further examination.

"These are powerful drugs with powerful side effects," says study author Judith Garrard, a professor at the university's School of Public Health in Minneapolis. "They need to be prescribed with caution."

While most of the patients in the study were already on antiepileptic drugs at admission, a significant number were prescribed the drugs within the first three months of entering a nursing home. But the researchers say it's possible the new residents had developed conditions or had prior symptoms that required such treatment.

"We can't say that these drugs are being over-prescribed -- it's not clear from this research," Garrard says.

The researchers found that 8 percent of residents had been taking antiepileptic drugs before admission and another 3 percent were placed on them shortly after settling in to their new home.

"This is surprising since many primary-care providers assume that few, if any, medications are initiated after an elderly person enters a nursing home," Garrard says.

Antiepileptic drugs are used to treat a host of conditions in the elderly, including epilepsy. While many people think of epilepsy as an early childhood condition, people over 65 are at the highest risk for the disorder.

These drugs are also prescribed for bipolar depression, nerve-generated pain and some behavioral problems associated with dementia.

"Antiepileptic drugs are used for more than just epilepsy. They're effective for certain types of pain. They're also used for behavioral disorders and, in some cases, migraines," says Tom Clark, director of professional affairs with the American Society of Consultant Pharmacists. "These drugs are very versatile."

In this study population, 60 percent of the patients taking antiepileptic drugs before admission were taking the drugs for seizures, while only 20 percent of those placed on the treatment after admittance took the drugs to prevent seizures.

Garrard cautions that antiepileptic drugs should not be prescribed carelessly because they can have dangerous interactions with other medications. For that reason, the drugs should really be prescribed with the consultation of a specialist, she says.

The study is the first of its kind to examine the prevalence of antiepileptic drug use in nursing homes. But Clark says the research does not necessarily raise red flags about overuse in the long-term care environment.

"I certainly am not aware of any widespread problems or adverse effects caused by [antiepileptic drug] use in nursing homes," Clark says.

More information

Read more about epilepsy drugs and the elderly from the Epilepsy Foundation. Learn more about nursing homes from the American Association of Homes and Services for the Aging.

SOURCES: Judith Garrard, Ph.D., professor, health research and policy, University of Minnesota School of Public Health, Minneapolis; Tom Clark, director, professional affairs, American Society of Consultant Pharmacists, Alexandria, Va.; May 5, 2003, Annals of Neurology

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