87% of older adults in long-term care facilities take CNS medications, highlighting need for better drug control

Nearly 87 percent of older adults in long-term care facilities in Korea take medications for the central nervous system (CNS), according to a new study.

The National Health Insurance Service (NHIS)' Health Insurance Research Institute said so at the “2024 Autumn Conference of the Korean Association of Health and Medical Sociology last Friday.

Central nervous system drugs work on the brain and spinal cord. The study included narcotic painkillers, antipsychotics, antianxiety drugs, sleeping pills, and antidepressants in that category of medications.

The researchers analyzed data from long-term care recipients in 2023 to determine the most recent use of central nervous system medications. They divided the number of days per year into one day and 28 days.

The study found that 79.2 percent of all long-term care service users took central nervous system medications on one or more days per year, with 86.8 percent of institutionalized recipients taking medications.

Among older adults who stay at long-term care facilities, the share of people who take central nervous system medications on more than one day per year was 86.8 percent, 9.6 percentage points higher than the share of care recipients who stay at their homes.

Among those who take these drugs 28 days or more per year, the shares of facility and home recipients were 76.7 percent and 56.6 percent, a difference of 20.1 percentage points, indicating a higher likelihood of long-term use of CNS medications among facility recipients than home recipients.

The drug group with the highest rate of one-day or more use among facility recipients was opioids, at 57.6 percent, followed by antipsychotics, at 53.2 percent. When looking at the number of cases with 28 or more days per year, antipsychotics were the most common (50.7 percent), followed by antidepressants (33.3 percent).

By the drug group usage rate, the usage rate of opioids was 57.6 percent for more than one day per year compared to 27.3 percent for more than 28 days per year, while the usage rate of antipsychotics was 53.2 percent and 50.7 percent for more than one day per year and more than 28 days per year, suggesting that most patients are taking them long-term.

Among antipsychotics, quetiapine was taken by the largest share of patients for more than one day at 46.1 percent. The rate for more than 28 days was also not significantly different at 45.1 percent, indicating that it is a drug with a high long-term use rate.

After quetiapine, dihydrocodeine-containing combinations for colds and tramadol-containing combinations for painkillers were most likely to be used for more than one day, but they ranked lower in long-term use over 28 days.

In addition, antipsychotic use was high among older adults at care facilities, and different central nervous system medication groups were often combined.

Assuming combinations refer to different groups of drugs prescribed for more than 180 days each in a single patient, the combination of antipsychotics and antidepressants was observed in 15.3 percent of patients, and the combination of antipsychotics and antianxiety drugs in 10.2 percent of patients.

“Narcotic painkillers, antipsychotics, antianxiety drugs, sleeping pills, and antidepressants are drugs for the central nervous system that must be carefully administered and adjusted only when necessary due to their potential for addiction and dependence, risk of falls and fractures, and cognitive decline, but they can be difficult to manage due to a lack of manpower and expertise in long-term care facilities,” said Professor Lee Jung-suk of the Department of Psychiatry at the National Health Insurance Service Ilsan Hospital.

NHIS plans to establish a long-term care facility model in the multi-drug management project from 2025 to provide drug management services to residents of long-term care facilities who need them. The research results will be used to develop a service model.