{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:00:57Z","timestamp":1790013657038,"version":"4.0.1"},"reference-count":56,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["5R01AG068450\u201003"],"award-info":[{"award-number":["5R01AG068450\u201003"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In 2024, 6.9 million Americans lived with Alzheimer's disease and related dementias (ADRD), with nursing homes serving as a major site of care. Antidepressants are the most prescribed psychotropic medications among nursing home residents with ADRD, yet detailed information on prescribing patterns, potential indications, and associated resident and facility characteristics remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using 2018 minimum data set 3.0 assessments linked to Medicare claims, we conducted a cross\u2010sectional study of long\u2010stay nursing home residents aged \u2265\u200965\u2009years with ADRD who were continuously enrolled in Medicare fee\u2010for\u2010service for 120\u2009days before their annual assessment. We described usage by drug class and type and compared characteristics of users versus non\u2010users overall and by potential indications: depression, anxiety, pain, and insomnia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 232,543 residents with ADRD, 51.6% used antidepressants. Fewer than 5% had moderate or severe depressive symptoms (PHQ\u20109\u2009\u2265\u200910). Use was highest among residents with depression or anxiety (69.5%), pain (61.9%), and insomnia (60.0%). Among those without these conditions, 14.1% were prescribed antidepressants. SSRIs were the most prescribed class (60.7%) overall. Citalopram, mirtazapine, sertraline, and trazodone were the most common medications. Residents with any current level of depression severity were more likely to use antidepressants compared to those without symptoms, whereas all levels of cognitive impairment were associated with lower use compared with cognitively intact residents with ADRD. Polypharmacy was strongly associated with increased use, while diabetes, heart failure, and stroke were associated with reduced use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Antidepressants were frequently prescribed to residents with ADRD despite limited documentation of active depressive symptoms. Limitations in accurately capturing depressive symptoms in nursing home records, including underreporting by residents due to cognitive impairment and reliance on staff observation rather than self\u2010report, may contribute to apparent discordance between symptoms and prescribing. Further research should evaluate treatment appropriateness, deprescribing opportunities, and risk\u2013benefit balance of chronic treatment in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70492","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T12:14:36Z","timestamp":1778069676000},"page":"1998-2010","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Antidepressant Use Among\n                    <scp>US<\/scp>\n                    Nursing Home Residents With Dementia"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7845-3534","authenticated-orcid":false,"given":"Shiwei","family":"Liang","sequence":"first","affiliation":[{"name":"Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9957-7747","authenticated-orcid":false,"given":"Kate L.","family":"Lapane","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4899-7116","authenticated-orcid":false,"given":"Brian R.","family":"Ott","sequence":"additional","affiliation":[{"name":"Department of Neurology Brown University Warren Alpert Medical School  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4541-0460","authenticated-orcid":false,"given":"Jennifer","family":"Tjia","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonggyu","family":"Baek","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8322-5648","authenticated-orcid":false,"given":"Yiyang","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Alcusky","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13809"},{"key":"e_1_2_11_3_1","first-page":"1","article-title":"Overview of Post\u2010Acute and Long\u2010Term Care Providers and Services Users in the United States, 2020","volume":"208","author":"Ledon J.","year":"2024","journal-title":"National Health Statistics Reports"},{"key":"e_1_2_11_4_1","unstructured":"National Academies of Sciences Engineering and Medicine \u201cMeeting the Challenge of Caring for Persons Living With Dementia and Their Care Partners and Caregivers: A Way Forward \u201d(2021) https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/33625814 https:\/\/www.nationalacademies.org\/read\/26026\/chapter\/1."},{"key":"e_1_2_11_5_1","volume-title":"Psychotropic Medications in the Skilled Nursing Facility\u2010AAPACN","author":"Denise","year":"2023"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.0379"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"e_1_2_11_8_1","unstructured":"Service CfMaM \u201cAntidepressant Medications: U.S. Food and Drug Administration\u2010Approved Indications and Dosages for Use in Adults \u201d2015 https:\/\/www.cms.gov\/sites\/default\/files\/repo\/ad%20adult%20dosing%20chart%20102915.pdf."},{"key":"e_1_2_11_9_1","unstructured":"C.Nelson \u201cSerotonin\u2010Norepinephrine Reuptake Inhibitors: Pharmacology Administration and Side Effects\u2010UpToDate \u201daccessed November 24 2024 UpToDate https:\/\/www\u2010uptodate\u2010com.umassmed.idm.oclc.org\/contents\/serotonin\u2010norepinephrine\u2010reuptake\u2010inhibitors\u2010pharmacology\u2010administration\u2010and\u2010side\u2010effects?search=snri&source=search_result&selectedTitle=3%7E149&usage_type=default&display_rank=1."},{"key":"e_1_2_11_10_1","unstructured":"M.HirschandR. J.Birnbaum \u201cSelective Serotonin Reuptake Inhibitors: Pharmacology Administration and Side Effects\u2010UpToDate \u201daccessed November 24 2024 UpToDate https:\/\/www\u2010uptodate\u2010com.umassmed.idm.oclc.org\/contents\/selective\u2010serotonin\u2010reuptake\u2010inhibitors\u2010pharmacology\u2010administration\u2010and\u2010side\u2010effects?search=antidepressants&source=search_result&selectedTitle=8%7E149&usage_type=default&display_rank=6."},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjopharm.2011.03.001"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2011.09.004"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18372"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41999\u2010023\u201000777\u2010y"},{"key":"e_1_2_11_15_1","unstructured":"Service CfMaM \u201cNational Partnership to Improve Dementia Care in Nursing Homes \u201d2024 https:\/\/www.cms.gov\/medicare\/health\u2010safety\u2010standards\/quality\u2010safety\u2010oversight\u2010general\u2010information\/national\u2010partnership\u2010improve\u2010dementia\u2010care\u2010nursing\u2010homes."},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnx182"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4452"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.1195"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18004"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glab373"},{"key":"e_1_2_11_21_1","unstructured":"United States Pharmacopeia (USP).Medicare Model Guidelines (MMG) Version 9.0. Rockville MD: United States Pharmacopeial Convention; Accessed May 4 2026 https:\/\/www.usp.org\/health\u2010quality\u2010safety\/usp\u2010medicare\u2010model\u2010guidelines."},{"key":"e_1_2_11_22_1","unstructured":"Cleveland Clinic \u201cAntidepressants: What They Are Uses Side Effects & Types \u201daccessed November 24 2024 https:\/\/my.clevelandclinic.org\/health\/treatments\/9301\u2010antidepressants\u2010depression\u2010medication."},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/54.11.m546"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000334"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5074"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2012.06.003"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16957"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.20f13681"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh090"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883\u2010023\u201003191\u2010w"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13195\u2010021\u201000867\u20108"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003944.pub2"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.3233\/jad\u2010161247"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13195\u2010021\u201000818\u20103"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.2165\/0003495\u2010200868170\u201000001"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263\u2010024\u201001110\u20102"},{"issue":"7","key":"e_1_2_11_37_1","first-page":"24","article-title":"Trazodone for Insomnia: A Systematic Review","volume":"14","author":"Jaffer K. Y.","year":"2017","journal-title":"Innovations in Clinical Neuroscience"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/1054773819838678"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1017\/S003329172200397X"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2019.10.022"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19256"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2020.07.004"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e1566"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912\u2010024\u201001932\u2010x"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875\u2010025\u201002894\u2010y"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igy023.1906"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.8519"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.4103"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010017\u20100440\u20105"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.1858"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1159\/000105603"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1177\/0891988706292762"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/22.052"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.2147\/ndt.s3201"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2023.1103039"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.13604"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2021.101362"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.70492","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgs.70492","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.70492","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:10:29Z","timestamp":1785460229000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.70492"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,6]]},"references-count":56,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/jgs.70492"],"URL":"https:\/\/doi.org\/10.1111\/jgs.70492","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,6]]},"assertion":[{"value":"2025-10-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}