A new study by the University of Minnesota of 500 nursing homes across the country found that most of these patients were already on antiepileptic drugs at admission, though a significant number were prescribed the drugs in the first three months after they entered a nursing home.
It is not surprising that many elderly are taking antiepileptic medications, note the authors of the study, published May 5 via Wiley InterScience in the on-line edition of the Annals of Neurology, the scientific journal of the American Neurological Association.
"Contrary to the popular belief that the occurrence of epilepsy is greatest among newborns and infants, the onset of this condition is actually highest among people over the age of 65," said lead author Judith Garrard, Ph.D., a professor at the University of Minnesota School of Public Health in Minneapolis.
"What has not been fully realized until recently is the extent to which these drugs are being used by elderly nursing home residents," Garrard said.
Antiepileptic drugs (AEDs) are effective in preventing seizures, and they are also prescribed for conditions such as bipolar depression, pain generated in nerve fibers, and some behavioral problems associated with dementia.
However, the use of AEDs is complicated and often calls for the input of a specialist who can determine which drug should be used. It is also important to note that some AEDs can have side-effects such as poor coordination, confusion, or sedation, and some may interact adversely with other types of medication, said Garrard.
It has been noted in previous research that AED use is much higher among nursing home residents than among elderly in the general population. As part of a grant from the National Institutes of Health to study AED use in the elderly, Garrard and her colleagues sought to find out whether the majority of nursing home patients taking AEDs were already on the medications before entering the home, or whether they were later prescribed the drugs.
The researchers studied the records of more than 10,000 elderly in more than 500 nursing homes around the country. They found that 8 percent of nursing home residents had been taking AEDs on admission to the homes, but they were surprised to find that another 3 percent were placed on AEDs within three months of admission.
“This is surprising since many primary care providers assume that few, if any, medications are initiated after an elderly person enters a nursing home," said Garrard.
Of the patients already taking AEDs before admission, 60 percent were taking the drugs for seizures. Conversely, only 20 percent of those placed on AEDs after admission received the drugs to prevent seizures.
"This is a foundation, and from here we hope to identify the most appropriate AED treatments for seniors and to use this information to help physicians, nursing home providers, patients, and families design more individualized care," said Garrard.
Journal
Annals of Neurology