Sociodemographics included age group, sex, competition/ethnicity, geographic area, and low-income subsidy position (yes/zero). in comparison to antipsychotics in the administration of old adults with Alzheimers disease and related dementias who knowledge moderate-to-severe behavioral symptoms. Clinicians have to measure the ongoing dangers/benefits of antidepressants for these symptoms specifically in light from the significantly prevalent usage of these agencies. [ICD-9-CM] rules of 290.0C290.4, 331.0C33.2, 331.7, 797) between 2007 and 2009; (ii) initiated antipsychotic or antidepressant agencies (Supplementary Desk 1); and (iii) had moderate-to-severe behavioral symptoms in the six months before or three months after the time of antidepressant or antipsychotic initiation (index time). Moderate-to-severe behaviors symptoms had been determined by the current presence of 4 times of some of three MDS-measured behaviors: verbally abusive (issue identifier E4ba), bodily abusive (issue identifier E4ca), and/or socially unacceptable (issue identifier E4da) (26). These behavioral symptoms might pose a threat to all those and remain so following nonpharmacological interventions. Therefore, these circumstances are recommended as befitting antidepressant and antipsychotic treatment predicated on the Centers for Medicare and Medicaid Providers guidance PNU-176798 for needless medicines (24). To recognize long-stay NH citizens, we relied with an algorithm that used both Medicare MDS and promises 2.0 data and identified an increased percentage of long-stay citizens than Medicare promises data alone, in comparison with MDS data only (27). This algorithm has been used in several studies (1,28). In this study, we also utilized 2006 Medicare data to determine whether residents discharged in JanuaryCMarch of 2007 qualified as long-stay residents, as well as to ascertain eligibility of pre-NH stay Medicare enrollments among residents whose earliest long-stay NH admission was on January 1, 2007. Residents with a short NH stay ( 101 days) were excluded due to lack of Part D prescription data which are bundled into Part A payments (29). To ensure the completeness of diagnosis and prescription data, residents were excluded if they had discontinuous Medicare Parts A, B, and D enrollment or had Medicare Advantage/Health Maintenance Organization insurance during the 6 months prior to the index date and thereafter until the date of outcome event (fall or fracture) or the end of study period (death, discharge from a NH, or December 31, 2009). Finally, to ascertain incident cases during the follow-up PNU-176798 period, we excluded patients who had diagnoses of falls or fractures within 6 months prior to the index date. Based on these inclusion and exclusion criteria, 6,644 eligible beneficiaries were selected from the 5% random sample of national Medicare data. Outcome Measure The primary outcomes of interest were incident fractures, accidental falls, and a composite outcome of a fracture or fall event requiring inpatient or outpatient (eg, physician visit, emergency room visit) care. The composite outcome was assessed because both fracture and fall events are strongly associated with use of psychopharmacological medications (8,10), are important causes of morbidity (9), and their relationship is intertwined and recursive (30). For example, patients who fall may also experience serious injury, such as bone fractures, and bone fractures further put patients at high risk of falls. Our composite measure may reflect the overall risk of falls and fractures associated with antidepressants versus antipsychotics, which provides integrated information for patients, their caregivers and clinicians when making decisions on psychopharmacological treatment for behavioral symptoms of ADRD. Fall or fracture outcomes were measured using Medicare claims data show a high accuracy of detecting cases with these outcomes, compared to medical records (31,32). We refrained from using MDS files to ascertain outcomes due to the under-reporting of fall cases in such data (33). Fractures were defined as having inpatient or outpatient claims with ICD-9-CM codes of 808.xx (pelvic fracture), 820.xx (upper femur fracture), 821.xx (lower femur fracture), or 733.1x (pathological fracture). We focused on hip/pelvic.We operationalized dose exposure using modified standardized daily dose, which compares the mean daily dose of each individual medication against its maximum allowable geriatric dose (1). Conclusions: Antidepressants are associated with higher fall and fracture risk compared to antipsychotics in the management of older adults with Alzheimers disease and related dementias who experience moderate-to-severe behavioral symptoms. Clinicians need to assess the ongoing risks/benefits of antidepressants for these symptoms especially in light of the increasingly prevalent use of these agents. [ICD-9-CM] codes of 290.0C290.4, 331.0C33.2, 331.7, 797) between 2007 and 2009; (ii) initiated antipsychotic or antidepressant agents (Supplementary Table 1); and (iii) had moderate-to-severe behavioral symptoms in the 6 months before or 3 months after the date of antidepressant or antipsychotic initiation (index date). Moderate-to-severe behaviors symptoms were determined by the presence of 4 days of any of three MDS-measured behaviors: verbally abusive (question identifier E4ba), physically abusive (question identifier E4ca), and/or socially inappropriate (question identifier E4da) (26). These behavioral symptoms may pose a threat to individuals and remain so after nonpharmacological interventions. Therefore, these conditions are suggested as appropriate for antidepressant and antipsychotic treatment based on the Centers for Medicare and Medicaid Services guidance for unnecessary medications (24). To identify long-stay NH residents, we relied on an algorithm that utilized both Medicare claims and MDS 2.0 data and identified a higher proportion of long-stay residents than Medicare claims data alone, when compared to MDS data only (27). This algorithm has been used in several studies (1,28). In this study, we also utilized 2006 Medicare data to determine whether residents discharged in JanuaryCMarch of 2007 qualified as long-stay residents, as well as to ascertain eligibility of pre-NH stay Medicare PNU-176798 enrollments among residents whose earliest long-stay NH admission was on January 1, 2007. Residents with a short NH stay ( 101 days) were excluded due to lack of Part D prescription data which are bundled into Part A payments (29). To ensure the completeness of diagnosis and prescription data, residents were excluded if they had discontinuous Medicare Parts A, B, and D enrollment or had Medicare Advantage/Health Maintenance Organization insurance during the 6 months prior to the index date and thereafter until the date of outcome event (fall or fracture) or the end of study period (death, discharge from a NH, or December 31, 2009). Finally, to ascertain incident cases during the follow-up period, we excluded patients who had diagnoses of falls or fractures within 6 months prior to the index date. Based on these inclusion and exclusion criteria, 6,644 eligible beneficiaries were selected from the 5% random sample of national Medicare data. Outcome Measure The primary outcomes of interest were incident fractures, accidental falls, and a composite outcome of a fracture or fall event requiring inpatient or outpatient (eg, physician visit, emergency room visit) care. The composite outcome was assessed because both fracture and fall events are strongly associated with use of psychopharmacological medications (8,10), are important causes of morbidity (9), and their relationship is intertwined and recursive (30). For example, patients who fall may also experience serious injury, such as bone fractures, and bone fractures further put patients at high risk of falls. Our composite measure may reflect the overall risk of falls and fractures associated with antidepressants versus antipsychotics, which provides integrated information for patients, their caregivers and clinicians when making decisions on psychopharmacological treatment for behavioral symptoms of ADRD. Fall or fracture outcomes were measured using Medicare claims data show a high accuracy of detecting cases with these outcomes, compared to medical records (31,32). We refrained from using MDS files to ascertain outcomes due to the under-reporting of fall cases in such data (33). Fractures were defined as having inpatient or outpatient claims with ICD-9-CM codes of 808.xx (pelvic HSPC150 fracture), 820.xx (upper femur fracture), 821.xx (lower femur fracture), or 733.1x (pathological fracture). We focused on hip/pelvic and lower femur fractures because they were highly associated with psychopharmacological medication use (17). We combined pelvic with hip fractures as a category because pelvic factures occur in the bones that make up the hip area. Accidental.