Spotlight on drug use in aged care

Residential aged care providers should rethink use of psychotropic medicines according to researchers behind the latest research in South Australia.

Dr Stephanie Harrison, the lead author of the SAHMRI-based Registry of Senior Australians (ROSA) study published in the Medical Journal of Australia, says use of “chemical restraints” for people in residential aged care has been a key focus of the recent Royal Commission into Aged Care Quality and Safety.

“There has been growing concern about the use of psychotropic medicines, especially antipsychotics, but it was previously unknown if people were already being prescribed these medicines before they moved to residential care,” Dr Harrison says.

“Our study showed that although the proportion of individuals receiving psychotropic medicines is generally high for older Australians before entering residential care, that proportion increased markedly after entering residential care.”

The research team examined seven years of national data that included more than 320,000 Australians entering permanent residential aged care. The data reveal 21 per cent of residents received antipsychotic medication within the first three months of their stay. Of these people, 46 per cent had not been prescribed antipsychotics in the 12 months before entering care.

“Antipsychotic medicines are associated with a higher risk of serious adverse events and should only be used in accordance with guidelines, at the lowest possible dose and with appropriate monitoring,” Dr Harrison says.

The study also showed 31 per cent of residents were given benzodiazepines and 38 per cent received antidepressants during the first three months of their stay. Of these people, 39 per cent and 20 per cent respectively had not received those medicines in the year before going to residential care.

The report authors, including geriatrician and Flinders University academic Dr Craig Whitehead, are calling on aged care providers to find alternatives to the use of psychotropic drugs.

“There are effective non-pharmacological approaches to help people experiencing changes in behaviour which are commonly experienced by people with dementia,” Professor Whitehead says.

“If you have a loved one taking one of these medications, or you’re unsure what medications they’re taking, speaking with their GP or aged care facility nursing staff is a great first step.

“Regular review of medications is always a good idea and they should be able to suggest whether the medication is still needed.”

Psychotropic medicines affect a person’s behaviour or mood. The psychotropic medicines investigated in the study were antipsychotics, benzodiazepines and antidepressants.

Antipsychotic medicines may help people with severe mental health conditions. In this study, the most common antipsychotic dispensed was risperidone (62 per cent of residents who received antipsychotics). Risperidone is indicated for managing severe, persistent psychological symptoms in people with dementia.

The most common benzodiazepine in this study was temazepam (62 per cent of residents who received benzodiazepines). Temazepam is often used to treat conditions such as sleep disturbance and anxiety.

The dispensing of psychotropic medicines before and after people enter residential aged care‘ by SL Harrison, JK Sluggett, C Lang, C Whitehead, M Crotty, M Corlis, SL Wesselingh and MC Inacio has been published in The Medical Journal of Australia.

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