Volume 200 - Issue 6

Psychotropic drug use in aged care facilities: a reflection of a systemic problem?

Author:  Ian Maddocks

Med J Aust 2014; 200 (6): 319. || doi: 10.5694/mja14.00091
Published online: 7 April 2014
The key to accessible and comprehensive aged care is to base general practices in aged care facilities

To the Editor: Looi and Macfarlane have raised the important matter of inappropriate psychotropic drug use in residential aged care facilities (RACFs).1 Many other problems affect care in RACFs, including:

  • lack of a comprehensive assessment of new residents, failing to address rationalisation of medications, risk assessment, advance directives and family support;

  • poor availability of medical personnel for crisis situations;

  • overdependence on locum services;

  • inappropriate transfers to acute care;

  • poor on-the-job support for staff;

  • inadequate palliative care for the many who die in RACFs.

Finding answers to these problems is increasingly urgent. We face an increasing population of dependent older citizens, many requiring residential care.

Too commonly, general practitioners are not providing the care in RACFs that is needed and is possible. We need medical practitioners prepared to specialise in this area, as happens in the Netherlands. Further training in psychogeriatrics and in palliative care will be needed, and a single comprehensive diploma program similar to what is offered by the Royal Australasian College of Physicians in palliative medicine would be ideal. Then, an improved remuneration for their RACF consultations could be considered.

But the key to better care will be basing general practices in the RACFs, offering consistent availability and comprehensive care. The morale of those who work in our RACFs would improve enormously if interested and proactive medical practitioners were incorporated into RACF teams. This would stimulate support from other allied health staff and, by offering their special care within the local community, would create a community aged care hub. That will maintain communication between hospital, home and the RACF, ensure continuity of care, and it will do much towards mending many current problems, including those raised by Looi and Macfarlane.


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