AUSTRALIAN researchers have reported encouraging downward trends in the use of psychotropic medications in residential aged care (RAC) facilities, suggesting that reforms introduced in the wake of the recent Royal Commission into Aged Care Quality and Safety have had a positive effect.

The team comprising researchers from centres around the country found that the use of antipsychotics, sedatives and anxiolytics, and antiseizure medication decreased significantly over the five-year study period.

However, the use of antidepressants did not decrease over the period, leading researchers to speculate they may be being used inappropriately for chemical restraint – defined as the use of medication to alter behaviour and restrict movement.

Often given to people with dementia in RAC to manage behavioural and psychological symptoms, the overuse and prolonged use of psychotropic medications as chemical restraints was highlighted in the Royal Commission, which ran from 2018 to 2021.

In addition to the risk of serious side effects, including falls, the medication is not particularly effective in managing symptoms.

Reforms arising from the findings of the Royal Commission included the use of alternatives to chemical restraint, increased documentation of their use, and mandatory reporting.

The research team set out to investigate the impact of the reforms, looking at rates of usage of psychotropic medicines in people with and without dementia in RAC over the period from Jan 2018, before the Royal Commission started, to Dec 2022.

Among people with dementia, antipsychotic use decreased over this time by around 43%, with a similar decrease in people without dementia (44%).

Among residents with dementia, risperidone was the most frequently administered antipsychotic, while quetiapine was the most common in residents without dementia.

The use of sedatives and anxiolytics decreased by 41% in people with dementia, and 36% in those without.

Oxazepam was the most frequently prescribed drug in this class for people with dementia, and temazepam in those without.

Antiseizure use decreased by 41% in those with dementia, and 25% in those without.

Among residents with dementia, the most frequent antiseizure medication was sodium valproate, compared with pregabalin in residents without dementia.

The use of antidepressants decreased by 5% among those without dementia, a non-significant result, and increased by 6% in those with dementia, which was also non-significant.

“Our analysis revealed declines in the administration of antipsychotics, sedatives and anxiolytics, and antiseizure medication in Australian RAC facilities during a period of government aged care reforms between 2019 and 2022,” the authors concluded.

“Ongoing monitoring, stratified by residents’ dementia status, is crucial to ensuring that the early declines in psychotropic medication use continue and that use of antipsychotics and other psychotropics is not being replaced by antidepressants,” they added.

Read the paper HERE. KB

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