Study focuses on chemical restraints in aged care
Recent Australian research reveals persistent high use of antipsychotics in aged care residents living with dementia.
What are psychotropic medications?
These are medicines which affect the mind, emotions, and behaviour and include several classes of drugs such as antipsychotics, antidepressants, sedatives, and anti-seizure medications.
They are prescribed to older people to treat conditions such as anxiety, difficulty in sleeping, and depression.
In those with dementia, antipsychotic medications are sometimes used to manage behavioural and psychological symptoms such as agitation, anxiety, and sleep disturbances.
They carry significant risks, including increased risk of stroke and death, and there is also limited evidence to show they make a difference to the symptoms, the researchers say.
Changes to the Aged Care Act in 2021 were supposed to reduce the use of chemical restraints in aged care homes, including the prescription of antipsychotics.
The measures were introduced after the Aged Care Royal Commission found psychotropic medicines were being misused and overused, particularly with older people and people with disability.
So, it comes as a surprise that residents with dementia are still prescribed antipsychotics at twice the rate of those without the condition.
Researchers from Macquarie University’s Australian Institute of Health Innovation analysed data from 2018 to 2022, covering nearly 38,000 residents across 428 aged care facilities.
While the study found encouraging declines in the use of antipsychotics, sedatives and antiseizure medications among residents both with and without dementia, antipsychotic prescribing remained twice as high in residents with dementia (23%) compared with those without (11%).
Antidepressant use among people with dementia rose from 42% in 2018 to 48% in 2022, with no sign of decline.
The use of psychotropic medicines can be appropriate for treating, or enabling the treatment of, a diagnosed mental disorder or a physical illness or physical condition.
However, using psychotropic medicines, such as antipsychotics and benzodiazepines, to calm, soothe, sedate or influence or control the behaviour of people who exhibit behaviours of concern is a restrictive practice, and the researchers say must be regulated.
Macquarie researcher, Associate Professor Magda Raban, said the rise in the use of antidepressants among people with dementia could suggest a shift away from antipsychotics, with antidepressants possibly perceived as a safer alternative.
“However, antidepressants also have side effects and limited evidence of benefit for behavioural symptoms, including depression, in dementia,” she said.
The researchers stressed that psychotropic drugs should only be used as a last resort, and for the shortest possible time, when other approaches fail.
Dr Raban said the objective of the study was to understand whether recent aged care reforms, particularly those following the 2018 Royal Commission, had influenced the use of psychotropic medications in residential aged care.
The measures included greater regulatory scrutiny, dementia support service availability, implementation of quality indicators, and medication reviews in aged care settings.
“Our findings suggest that the government reforms may be contributing to positive changes,” she said.
“This was encouraging and reflects the commitment among many aged care providers to delivering quality care.
“However, there is a plateau in the decline suggesting further improvements are possible.
“A persistent two-fold higher use of antipsychotics in residents with dementia and a rising trend in antidepressant use among people with dementia, highlight areas needing urgent attention.”
Dr Raban said the increase in drug use was concerning because it meant people with dementia were still being disproportionately exposed to medications that carry serious risks.
“This highlights the need for continued efforts to promote safer, more appropriate care strategies for this group.”
She said the findings warrant careful monitoring, to make sure antidepressants don’t replace antipsychotics.
The researchers recommend that aged care providers, clinicians, and families all have a role to play in the future in reducing unnecessary psychotropic use and that ongoing investment in workforce training, dementia support programs, medication reviews, and leveraging the technology is necessary.
Related reading: Inside Ageing, Macquarie, Science Direct, Aged Care Quality
