An analysis of national U.S. nursing home data from 2013 to 2023 examined whether the well-documented decline in antipsychotic prescribing was distributed evenly across facilities. Aggregate improvement appears to coexist with a widening separation between the highest- and lowest-performing facilities, a divergence associated with structural vulnerability and the pandemic period. For older adults, exposure to these medications carries consequences for cognition, mobility, and mortality risk that extend well beyond the prescribing decision itself.
Key Points
- National antipsychotic declines mask widening facility-level disparities, 2013–2023
- Structurally vulnerable nursing homes diverged further during the pandemic
- Aggregate quality metrics can conceal concentrated prescribing burden
Longevity Analysis
Chemical restraint in late life represents interference imposed from outside the individual — sedating medications that blunt alertness, destabilize gait and balance, and suppress the very behavioral signals that should prompt investigation of pain, infection, dehydration, or unmet need. The distributional finding carries a specific lesson for anyone evaluating health systems or personal protocols: population averages can improve while the exposure concentrates in those least able to escape it. Where an older adult receives care increasingly determines whether distress is interpreted and addressed or pharmacologically silenced.
Original published by SAGE Research on Aging, by Adam J. Funk, Roy T. Sabo, Stephen Petterson, J. William Kerns, Danya M. Qato, Katherine M. Winter, Nicole Brandt, Linda Wastila, YoonKyung Chung, Yu-Hua Fu, Rebecca Etz, Alex H. Krist, Jonathan D. Winter1Department of Biostatistics, Virginia Commonwealth University School of Public Health, Richmond, VA, USA2Department of Family Medicine and Population Health, 6886Virginia Commonwealth University School of Medicine, Richmond, VA, USA3Shenandoah Valley Family Practice Residency, Front Royal, VA, USA4Peter Lamy Center on Drug Therapy and Aging, 15513University of Maryland School of Pharmacy, Baltimore, VA, USA516010Shenandoah University School of Nursing, Winchester, VA, USA6504352Harvey L. Neiman Health Policy Institute, Reston, VA, USA7Larry A. Green Center, Richmond, VA, USA.