By Linda Belardi.
Psychotropic medications are being used in residential aged care to excess, in dangerous combinations and without adequate consent, according to a series of damning editorials published in the Medical Journal of Australia.
Geriatrician and Clinical Pharmacologist Associate Professor Sarah Hilmer and NHMRC Early Career Fellow Dr Danijela Gnjidic, said that a shift to non-pharmacological management of behavioural and psychological symptoms of dementia in aged care facilities was urgent.
The authors said that while research supports use of psychotropics (antipsychotics, hypnotics, anxiolytics and antidepressants) in some clinical scenarios, they are being used “too often and for too long” at high doses in residential aged care with harmful effects.
In their article ‘“Rethinking psychotropics in nursing homes” first published in February, they said there was limited data supporting the efficacy of psychotropic medications in residential aged care residents, and in most cases antipsychotics could be safely withdrawn from nursing home patients with dementia, with stable or reduced symptoms in most.
Growing evidence has also linked psychotropic use in residents with increased risks of falls, pneumonia, hospitalisation and even death.
“Increasing exposure to psychotropics, with respect to dose, duration and number of drugs, is associated with more adverse events,” they said.
Hilmer and Gnjidic called for economic evaluations of pharmacological and non-pharmacological therapies for residents and increased investment in recruitment and training of staff.
While non-pharmacological management options often showed similar effects to pharmacological management, these strategies require skilled nursing and allied health staff, which is limited in aged care, they said.
In a second editorial published on Monday, Hilmer and Gnjidic said staff education alone was insufficient to address the complex issues affecting psychotropic drug use in nursing homes and better access to GPs, geriatricians, psychogeriatricians, psychologists, pharmacists and nurses or nursing aids was needed.
Provision of these services in aged care may require changes to healthcare and funding models, they said.
Westbury and Peterson said they had recently completed a national psychotropic audit of over 9000 nursing home medication reviews from 2011–12, which showed that more than a quarter of residents reviewed (27%) were taking antipsychotic medication.
They said an overestimation of the efficacy of psychotropic medications and limited awareness of their adverse effects was contributing to high levels of prescribing.
Westbury and Peterson said that through local audits, benchmarking and nurse education in 15 Tasmanian nursing homes, antipsychotic and benzodiazepine use had been reduced significantly over a 6-month period.
Westbury and Peterson are currently involved in RedUSe, a national project which aims to reduce the use of sedatives in residential aged care, targeting 150 homes over three years. The project is currently being rolled out in partnership with the Department of Health and Ageing (DoHA), the National Prescribing Service and the Pharmaceutical Society of Australia.
Glenn Rees, CEO of Alzheimer’s Australia called on the federal government to do more to protect the legal and human rights of nursing home residents.
“We need to ensure that more funding is targeted to those with complex care needs, and that it results in better trained staff and better designed facilities,” he said.
“We know that well-designed facilities with adequate numbers of staff trained to use psychosocial approaches such as Montessori techniques can provide personalised care to people with dementia. This can avoid many of these problems and keep people safe,” said Rees.
See the May-June edition of Australian Ageing Agenda 2013 for an in-depth report on the overuse of antipsychotics in aged care.