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Change in psychotropic prescribing among residents


The use of antipsychotics in residential aged care has gone down but other medications with similar side effects are being used more often, according to University of Tasmania research.

The researchers are repeating calls for more emphasis on the use of non-pharmalogical interventions as the first line of treatment.

The study reviewed the psychotropic prescribing data of 11,368 residents from 150 residential aged care facilities across the country between April 2014 and October 2015.

It found that regular antipsychotic use in residential facilities appears to have gone down but the use of benzodiazepines, which are given to treat symptoms of anxiety or agitation or as sleeping tablets, is higher.

The prescribing of these medications on an “as required” basis and sedating antidepressants is also in widespread use, the study published recently in the Australian & New Zealand Journal of Psychiatry found.

The results show some positive developments but also highlight areas on concern, said lead researcher Dr Juanita Westbury, from the Wicking Dementia Research and Education Centre at the University of Tasmania.

Dr Juanita Westbury

“There has been a notable decrease in one kind of drug but there’s been a move to other medications with less evidence but still similar side effects,” Dr Westbury told Australian Ageing Agenda.

It appears prescribers are responding to evidence about the harmful effects of antipsychotics and are looking for alternatives but unfortunately they are replacing them with other potentially harmful drugs, Dr Westbury said.

“You can’t give a drug with sedating properties and expect there to be no repercussions because we know that all of them increase the rates of falls. They also reduce residents’ engagement.”

“We really have to emphasise the use of non-pharmalogical treatments first; that is to assess why someone is agitated or why they might be having sleeping problems,” she said.

This apparent replacement of antipsychotics for other drugs has also been found in Europe and the US, Dr Westbury said.

Key findings

Nearly two-thirds of residents were taking psychotropic drugs regularly (61 per cent), and over one-third were taking an antipsychotic and/or a benzodiazepine every day (37 per cent), according to the findings.

Around 22 per cent of residents in the study were prescribed antipsychotics, which is down from a prevalence rate of around 28 per cent found in 2010 research, Dr Westbury said.

Over 41 per cent of residents were prescribed antidepressants, more than 16 per cent of the residents were taking sedating antidepressants, and 22 per cent or residents were taking benzodiazepines.

South Australian residents were more likely to be taking benzodiazepines than residents in other states, a finding which is consistent with previous research, said Dr Westbury.

She said the widespread use of as required (PRN) prescribing of benzodiazepines (over 30 per cent) and antipsychotics (11 per cent), which in some cases was in addition to a prescribed daily dose, was a concern.

There is safety risk of residents being administered too much of a drug and another of staff going to emergency PRN use rather than trying non-pharmalogical methods first, she said.

“It is not good practice to be using this medication PRN on a continual basis.”

Education needed

Dr Westubury said the sector was moving in the right direction, but there was a need for more education to raise awareness of the usage rates and adverse effects of these drugs and of other ways residents’ symptoms can be managed.

The data analysed in this study is the baseline for the federally-funded Reducing Use of Sedatives (RedUSe) expansion project, an initiative to promote the appropriate use of antipsychotics and benzodiazepines in 150 facilities (read our previous coverage here).

The results of the national project, which was implemented between April 2014 and April 2016, are expected to be published mid-year.

Access the paper here.

Related coverage

New recommendations to guide aged care on appropriate medicines use

New clinical guidelines for dementia care caution on antipsychotics, antidepressants

Intervention program effectively reducing sedative use

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One Response to Change in psychotropic prescribing among residents

  1. Malcolm O'Brien-Rogers March 22, 2018 at 8:29 am #

    Regarding the poll on cameras in aged care facilities, the one I live in already has cameras which on occasions have been very useful. Many feel they are an invasion of privacy, but weighing up the problems they help solve, i.e, theft, and disputes over other things, they’re an asset.

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