The impact of psychotropic reduction within aged care facilities

Objective: Psychotropic medications (predominantly antipsychotics and benzodiazepines) are commonly prescribed in residential aged care facilities (RACFs). Antipsychotics are often used to treat behavioural symptoms and benzodiazepines are frequently given for sleep disturbances and anxiety. Despite modest efficacy for these symptoms and risk of severe adverse effects, evidence suggests that psychotropics are not regularly reviewed or reduced, due to fears that these symptoms may deteriorate. Previous psychotropic reduction programs have lacked resident and staff outcome monitoring, impacting upon their suitability for detecting barriers to psychotropic reduction. The aim of this research is to assess the impact that psychotropic reduction has on residents and staff of RACFs involved in a multifaceted intervention program to improve psychotropic prescribing (the Reducing the Use of Sedatives; RedUSe project).

Methods: The RedUSe project consists of repeated educational sessions supported by auditing and benchmarking of psychotropic prescribing, and multidisciplinary psychotropic reviews. This prospective cohort study aims to recruit over 200 residents taking regular antipsychotics and/or benzodiazepines from approximately 40 RACFs involved in the RedUSe project. The primary outcome will be behavioural symptoms. Secondary outcomes include quality of life, social engagement, rate of falls, and caregiver burden and job satisfaction. Primary and secondary outcomes will be assessed at baseline and four months after the intervention to detect relationships associated with changes in psychotropic usage.

Results: Baseline and four month results will compare residents who do and do not have their psychotropic medication reduced. Staff-related outcomes will be examined for relationships with resident behaviours and overall change in psychotropic use. Results for most of the sample population are expected to be available for presentation at the 48th AAG National Conference.

Conclusion: The translation of psychotropic reduction into resident and staff outcomes will address the absence of clinical monitoring and reporting from similar psychotropic reduction programs.