Volume 194 - Issue 5
A 2009 survey of psychotropic medication use in Sydney nursing homes
Authors: John Snowdon, Daniel Galanos and Divya Vaswani
Med J Aust 2011; 194 (5): 270-271. || doi: 10.5694/j.1326-5377.2011.tb02968.x
Published online: 7 March 2011
Published online: 7 March 2011
To the Editor: Two studies in nursing homes in Sydney, New South Wales, in the 1990s1,2 showed inappropriately high use of psychotropic medications. A similar study was conducted in 2003.3 Over time, revision of management guidelines, warnings about potentially lethal side effects, and introduction of new drugs have contributed to changes in the pattern of use of psychotropic medications in aged care facilities.
Following the same procedure as the earlier studies, in 2009, we examined medication use in nursing homes in half the catchment area of Sydney South West Area Health Service (SSWAHS). We obtained details of drugs prescribed for residents from medication record cards in 44 of the area’s 48 nursing homes and checked whether medications had been given as prescribed. If given regularly on at least 25 of the previous 28 days, use was recorded as regular. We noted whether medication prescribed “as required” had been taken. The SSWAHS ethics review committee approved the study.
Medication cards of all 2465 residents (895 men, 1570 women; mean age, 78.7 and 84.2 years, respectively) were reviewed. The mean number of all medications charted per resident was 8.7.
Data obtained from all four surveys on patients taking psychotropic medication regularly are shown in the Box. The catchment area expanded between the 1998 and 2003 surveys. However, half the nursing homes open in 1993 closed before 2009. Use of antipsychotic agents fell between 1993 and 1998. By 2003 there had been a change from conventional antipsychotics to a two-to-one preference for atypical antipsychotic medication. Since 2003, regular use of antipsychotic medication has increased by about 19%, although at a lower mean dosage than previously. The rise is mainly attributable to increased prescription of risperidone and needs continuing review to monitor for morbidity. The proportion of residents taking antipsychotic medication only as required has remained almost the same in each survey (range, 1.2%–1.4%).
Regular use of anxiolytic and hypnotic medication has decreased, and of antidepressants has increased, since the 1990s. Only 3.5% of residents were regularly taking a tricyclic antidepressant in 2009. The proportions of residents prescribed anxiolytic or hypnotic medication only as required have also fallen (to 3.8% and 2.3%, respectively, in the 28 days preceding our audit).
Our findings cannot be generalised. Recent evidence from Tasmania4 showed that 42% of residents were taking benzodiazepines regularly. Nevertheless, changes in medication use should provoke discussion.
Number (%*) of Sydney nursing home residents taking psychotropic medication regularly
Acknowledgements
Janssen-Cilag provided funding for this repeat survey but had no other involvement in the study. We thank the staff of the nursing homes for providing access to records, and Leanne Pratt for assistance with collecting data.
References
- Snowdon J, Vaughan R, Miller R, et al. Psychotropic drug use in Sydney nursing homes. Med J Aust 1995; 163: 70-72.
- Snowdon J. A follow-up survey of psychotropic drug use in Sydney nursing homes. Med J Aust 1999; 170: 299-301. 0_i1096190
- Snowdon J, Day S, Baker W. Current use of psychotropic medication in nursing homes. Int Psychogeriatr 2006; 18: 241-250. 0_i1096192
- Westbury JL, Jackson S, Peterson GM. Psycholeptic use in Tasmanian aged care homes. J Clin Pharm Ther 2010; 35: 189-193. 0_i1096195