• Kaisu H Pitkala, Anna-Liisa Juola, Helka Hosia, Mariko Teramura-Gronblad, Helena Soini, Niina Savikko, and J Simon Bell.
• Unit of Primary Health Care, Department of General Practice, and Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland. Electronic address: kaisu.pitkala@helsinki.fi.
• J Am Med Dir Assoc. 2015 Nov 1; 16 (11): 973-8.

ImportanceIt is recognized that pain has been undertreated and psychotropic medications overused in institutional settings.ObjectiveTo investigate the change in prevalence of opioids, other analgesics, and psychotropic medications in institutional settings over an 8-year period.SettingsInstitutional settings in Helsinki, Finland.ParticipantsOlder residents in nursing homes in 2003 (n = 1987) and 2011 (n = 1576) and in assisted living facilities in 2007 (n = 1377) and 2011 (n = 1586).Outcome MeasuresComparable audits of medication use were conducted among institutionalized residents at 3 time points over 8 years. The prevalence of regular opioid, other analgesic, and psychotropic medications was compared across the 3 time periods.ResultsNursing home and assisted living facility residents were older; more disabled, had a higher prevalence of dementia, and greater comorbidity in the latter cohorts. The prevalence of regular opioid use was 11.8% and 22.9% in nursing homes in 2003 and 2011 (P < .001), and 8.6% and 17.3% in assisted living facilities in 2007 and 2011 (P < .001), respectively. The prevalence of regular acetaminophen and pregabalin/gabapentin increased and NSAIDs decreased in both nursing homes and assisted living facilities. The prevalence of regular antipsychotic use decreased from 42.6% to 27.8% in nursing homes (P < .001) but increased from 26.9% to 32.0% in assisted living facilities (P = .0017). The mean number of psychotropic medications (antipsychotics, antidepressants, anxiolytics, hypnotics) per resident decreased from 1.9 in 2003 to 1.0 in 2011 in nursing homes (P < .001) but increased from 1.1 to 1.2 in assisted living facilities (P = .040).ConclusionsThe prevalence of opioid use in institutional settings has doubled during the past decade. The prevalence of psychotropic medications has decreased in nursing homes but increased in assisted living facilities. The increase in opioid use may reflect improved recognition and treatment of pain. However, initiatives are needed to monitor opioid-related adverse drug events and ensure appropriate use of psychotropic medications, particularly in assisted living facilities.Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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