Psychotropic medication utilisation in Australian nursing home medication reviews

Objective: High rates of psychotropic medication use have been reported in nursing homes for several decades. In Australia one strategy to address this problem was the introduction of residential medication management reviews (RMMRs) whereby pharmacists review medication regimes of residents on an annual basis. The objective of the study was to obtain an upto-date assessment of psychotropic medication utilisation in a large sample of Australian RMMRs.

Method: A national sample of RMMRs conducted from July 2011 to June 2012 (n = 9503) was audited to evaluate psychotropic utilisation. Exclusion criteria included a ‘diagnosis of bipolar disorder or schizophrenia’ and incomplete data. Bivariate analysis was performed using χ2 tests and logistic regression was used to determine predictive factors associated with antipsychotic medication use.

Results: Over 70% of the Australian nursing home residents reviewed were prescribed psychotropic medication (n = 6722). Specifically, 27% were taking antipsychotics, 43% antidepressants and 40% benzodiazepines. Of particular concern was the high level of multiple psychotropic use, with 20% of residents taking antidepressants and benzodiazepines and 14% taking antipsychotics and benzodiazepines concurrently. Multivariate logistic regression analysis revealed that residents with a diagnosis of dementia were 3.6 (95%CI: 3.22–4.12) times more likely to be prescribed an antipsychotic medication. Men were 1.3 (95%CI: 1.18–1.51) times more likely to be on an antipsychotic than women. Taking multiple psychotropic agents also had a significant effect: Residents taking a benzodiazepine were 1.8 (95%CI: 1.60–2.02) times more likely and those taking an antidepressant 1.4 (95%CI: 1.24–1.56) times more likely than someone not on these medications to be taking an antipsychotic agent.

Conclusion: Despite repeated warnings of limited effectiveness and significant risk associated with psychotropic medication use and other initiatives such as RMMRs, the residents of Australian nursing homes continue to be prescribed excessive amounts of psychotropic medication. Urgent action to address overreliance on psychotropic medication is warranted.