*2.2.5 Additional analyses*

Because of the statistical significance of LTCH as a random effect in all the preceding analyses, we report here on additional analyses that explore whether

**17**

*Psychotropic Medication Use and Mortality in Long-Term Care Residents*

particular differences among LTCH contribute to fixed effect relationships to mortality. Specifically, the analyses include facility-level covariates that correspond with previously significant, resident-level fixed effect terms. These centered facilitylevel covariates are LTCH means for age, level of activity limitation, and mortality risk (i.e., CHESS scores); and percentages of residents by gender and psychotropic prescription on a PRN basis. The findings indicate that these facility-level variables have significant zero-order relationships with mortality in the same directions as the corresponding resident-level measure. However, all are nonsignificant when added to the list of fixed effects described in the preceding section (i.e., Section 2.2.4), with the odds-ratios and significance levels for resident-level terms showing minimal change from those in **Table 8**. We conclude, therefore, that the findings with resident-level fixed effects show negligible influence due to distributions in LTCH.

This chapter charts a journey of scientific investigation with the following

1.Concern about excess mortality with the use of antipsychotic medication.

3.Findings that excess mortality with PRN prescription applies to all types of

4.Findings of attenuated mortality with daily prescription for some types of psychotropic medication but augmented mortality with PRN prescription for

5.Evidence to support the preceding after control for confounders that include a

6.Findings that diagnosed dementia relates positively to the number of daily but negatively to the number of PRN prescriptions, whereas higher mortality risk relates negatively to the number of daily but positively to the number of PRN

7.Evidence that a combination of daily and PRN prescriptions of psychotropics overturns protective effects against mortality associated with the former but

The journey began with concern about excess mortality with the use of antipsychotic medication but ends with evidence for minor protective effects of daily prescription. How do we account for this discrepancy? Consider, first, the quality of measurement and, second, the appropriateness of the analyses. We have confidence in the data quality and psychometric adequacy (i.e., reliability and validity) of the RAI 2.0 measures. For nearly 30 years, efforts by researchers from across the world tried to ensure good measurement quality. A recent example is research on 15 years of archived data in Canada. Those authors report favorable outcomes, concluding that the RAI 2.0 provides a "robust, high quality data source" ([28], p. 27). If our data possess unrecognized error in measurement, similar error likely contaminates findings from many hundred referred

lowers deleterious effects associated with PRN prescribing.

2.Findings that limit the preceding relationship to PRN prescription.

*DOI: http://dx.doi.org/10.5772/intechopen.85971*

**2.3 Discussion**

psychotropic medication.

all types of medication.

prescriptions.

proven indicator of mortality risk.

publications that rely on RAI 2.0 data.

milestones:

*Psychotropic Medication Use and Mortality in Long-Term Care Residents DOI: http://dx.doi.org/10.5772/intechopen.85971*

particular differences among LTCH contribute to fixed effect relationships to mortality. Specifically, the analyses include facility-level covariates that correspond with previously significant, resident-level fixed effect terms. These centered facilitylevel covariates are LTCH means for age, level of activity limitation, and mortality risk (i.e., CHESS scores); and percentages of residents by gender and psychotropic prescription on a PRN basis. The findings indicate that these facility-level variables have significant zero-order relationships with mortality in the same directions as the corresponding resident-level measure. However, all are nonsignificant when added to the list of fixed effects described in the preceding section (i.e., Section 2.2.4), with the odds-ratios and significance levels for resident-level terms showing minimal change from those in **Table 8**. We conclude, therefore, that the findings with resident-level fixed effects show negligible influence due to distributions in LTCH.
