{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T00:42:20Z","timestamp":1793580140030,"version":"4.5.0"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Several antidementia medications have been approved for symptomatic treatment of cognitive and functional impairment due to Alzheimer disease. Antipsychotics are often prescribed off-label for behavioral symptoms.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>The aim of this study was to describe the basis for regional variation in antidementia and antipsychotic medication use.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>US nursing homes (n=9735), hospital referral regions (HRR; n=289).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Subjects:<\/jats:title>\n            <jats:p>Long-stay residents with dementia (n=273,004).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Using 2018 Minimum Data Set 3.0 linked to Medicare data, facility information, and Dartmouth Atlas files, we calculated prevalence of use and separate multilevel logistic models [outcomes: memantine, cholinesterase inhibitor (ChEI), antipsychotic use] estimated adjusted odds ratios (aOR) and 95% CIs for resident, facility, and HRR characteristics. We then fit a series of cross-classified multilevel logistic models to estimate the proportional change in cluster variance (PCV).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Overall, 20.9% used antipsychotics, 16.1% used memantine, and 23.3% used ChEIs. For antipsychotics, facility factors [eg, use of physical restraints (aOR: 1.08; 95% CI: 1.05\u20131.11) or poor staffing ratings (aOR: 1.10; 95% CI: 1.06\u20131.14)] were associated with more antipsychotic use. Nursing homes in HRRs with the highest health care utilization had greater antidementia drug use (aOR memantine: 1.68; 95% CI: 1.44\u20131.96). Resident\/facility factors accounted for much regional variation in antipsychotics (PCV<jats:sub>STATE<\/jats:sub>: 27.80%; PCV<jats:sub>HRR<\/jats:sub>: 39.54%). For antidementia medications, HRR-level factors accounted for most regional variation (memantine PCV<jats:sub>STATE<\/jats:sub>: 37.44%; ChEI PCV<jats:sub>STATE<\/jats:sub>: 39.02%).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>Regional variations exist in antipsychotic and antidementia medication use among nursing home residents with dementia suggesting the need for evidence-based protocols to guide the use of these medications.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/mlr.0000000000002016","type":"journal-article","created":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T18:01:35Z","timestamp":1717524095000},"page":"511-520","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Geographic Variation of Antidementia and Antipsychotic Medication Use Among US Nursing Home Residents With Dementia"],"prefix":"10.1097","volume":"62","author":[{"given":"Alison","family":"Rataj","sequence":"first","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Division of Epidemiology, University of Massachusetts Chan Medical School, Worcester, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Alcusky","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Division of Epidemiology, University of Massachusetts Chan Medical School, Worcester, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonggyu","family":"Baek","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Chan Medical School, Worcester, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Ott","sequence":"additional","affiliation":[{"name":"Department of Neurology, Alpert Medical School of Brown University, Providence, RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate L.","family":"Lapane","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Division of Epidemiology, University of Massachusetts Chan Medical School, Worcester, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,5,29]]},"reference":[{"key":"R1-20250806","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1055\/s-0039-1678581","article-title":"Current and future treatments in Alzheimer\u2019s disease","volume":"39","author":"Atri","year":"2019","journal-title":"Semin Neurol"},{"key":"R2-20250806","first-page":"CD005593","article-title":"Cholinesterase inhibitors for 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