First Advisor

Paula Carder

Term of Graduation

Fall 2021

Date of Publication


Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Community Health


OHSU-PSU School of Public Health




Antipsychotic drugs -- Therapeutic use, Long-term care facilities -- Pharmaceutical services -- Oregon, Dementia -- Patients -- Long-term care, Alzheimer's disease -- Patients -- Long-term care, Long-term care of the sick



Physical Description

1 online resource (ix, 146 pages)


Antipsychotic medication use (APU) in assisted living and residential care (AL/RC) settings is an under-studied and controversial health policy issue. APU in older adults with dementia is associated with an increased risk of falls, hospitalizations, and early mortality. I operationalize the Institutional Analysis and Development Framework using a situational analysis approach, an extension of grounded theory methods, to explore the APU in Oregon AL/RC settings. Regulatory deficiency citations, Oregon AL/RC population data, and semi-structured interviews suggest that staff role clarity, organizational characteristics, and perceived agency influence decision-making around APU. AL/RC providers and caregivers are forced to simultaneously balance and prioritize regulatory goals, organizational constraints, and complex care provision resulting in a multilayered, complicated, and unique situation. Findings highlight the need for creative policy and population health-minded solutions that reflect the practical reality of providing care in AL/RC settings to promote quality of life for residents.


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