Volume 199 - Issue 2
Rethinking psychotropics in nursing homes
Authors: Juanita L Westbury and Gregory M Peterson
Med J Aust 2013; 199 (2): 98. || doi: 10.5694/mja13.10192
Published online: 22 July 2013
Published online: 22 July 2013
The problem of excessive psychotropic drug use in Australian nursing homes is well known, but where are the solutions?
To the Editor: We thank Hilmer and Gnjidic for highlighting the excessive use of psychotropic medications in Australian nursing homes.1 We recently completed a national psychotropic audit of over 9000 nursing home medication reviews conducted during the 2011–12 financial year. Our results were alarming: even after excluding residents with schizophrenia or bipolar disorder, more than a quarter of residents reviewed (27%) were taking antipsychotics. Concerningly, 41% of all residents reviewed were prescribed benzodiazepines.
Such findings are not new. The problem of excessive psychotropic use in Australian nursing homes has been reported for nearly 20 years and has been the subject of both federal and state inquiries.
As possible solutions, Hilmer and Gnjidic suggest economic evaluations and investment in staff and in research to develop better management strategies.1 Yet, qualitative research has determined that a major reason for high prescribing lies in an overestimation of the efficacy of psychotropic medications and limited awareness of their adverse effects.2 Consequently, awareness-raising and education of health practitioners and residents’ relatives is key.
We would also like to emphasise that programs to reduce psychotropic use in Australian nursing homes have proven successful in controlled trials. Resident and staff education reduced benzodiazepine use by half in a South Australian nursing home.3 Likewise, through local audit, benchmarking and nurse education in 15 Tasmanian nursing homes, antipsychotic and benzodiazepine use was reduced significantly over a 6-month period.4 It is time to move beyond describing psychotropic usage patterns and evaluating solutions to implementing these successful intervention strategies on a wider scale.
Competing interests
No relevant disclosures.
References
- Hilmer SN, Gnjidic D. Rethinking psychotropics in nursing homes. Med J Aust 2013; 198: 77. 0_CHDGIGGD
- Cornege-Blokland E, Kleijer BC, Hertogh CM, van Marum RJ. Reasons to prescribe antipsychotics for the behavioral symptoms of dementia: a survey in Dutch nursing homes among physicians, nurses, and family caregivers. J Am Med Dir Assoc 2012; 13: 80.e1-80.e6. 0_CBBHAGBC
- Gilbert A, Owen N, Innes JM, Sansom L. Trial of an intervention to reduce chronic benzodiazepine use among residents of aged-care accommodation. Aust N Z J Med 1993; 23: 343-347. 0_i1142869
- Westbury J, Jackson S, Gee P, Peterson G. An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project. Int Psychogeriatr 2010; 22: 26-36. 0_i1142873