Real-World Claims Analysis to Characterize the Burden of Tardive Dyskinesia in Long-Term Care Settings.

Introduction: Tardive dyskinesia (TD), a persistent and often debilitating movement disorder, is associated with prolonged exposure to dopamine receptor-blocking agents. Individuals aged ≥ 60 years are at increased risk for TD and TD-related burden (e.g., impaired balance, difficulty swallowing), which can complicate management in long-term care (LTC) settings. We evaluated the prevalence of TD diagnoses and characterized the populations, treatment patterns, and healthcare resource utilization within specific LTC settings.

Methods: This retrospective, longitudinal, observational study used the STATinMED Real-World Insights Database (1/2017-12/2012). Commercial, Medicaid, and Medicare enrollees with a TD diagnosis code who had ≥ 1 LTC stay, continuous claims data capture for ≥ 1 year pre-LTC facility admission, and ≥ 1 year post-LTC facility discharge were included. Demographics and clinical characteristics were captured for 12 months pre-LTC index stay. Clinical outcomes were collected for 12 months post-index LTC stay.

Results: Of 20,176 patients identified, 2294 had ≥ 2 years continuous benefits and were included. Most patients were aged ≥ 65 years (64.6%), female (67.3%), and Medicare enrollees (76.8%). Mean Charlson Comorbidity Index score was 3.72 (standard deviation: 4.2) for all patients, suggesting high comorbidity burden. Two-thirds (66.1%) of the population had mood disorders, and antidepressants were the most widely used medication (56.1%). Polypharmacy was prevalent: nearly half (47.9%) of the population was prescribed ≥ 3 medications with central nervous system properties, which can increase risk of falls and cognitive impairment in older adults; 64.8% of patients had ≥ 1 emergency department visit any time post-LTC stay.

Conclusions: Our findings demonstrated individuals with TD in LTC settings have a high comorbidity burden and polypharmacy, particularly for medications with anticholinergic properties. Further investigation is warranted to evaluate the impact of TD in older adults in LTC settings and explore interventional practices that can improve clinical outcomes, such as falls with injury and activities of daily living decline.