Regular clinical reviews of psychotropic medication should be established in all care homes to promote safe and effective prescribing to an at-risk population of elderly people, according to a new study by researchers at the University of Dundee and NHS Fife, published today in Age & Ageing, the scientific journal of the British Geriatrics Society.
The use of psychotropic drugs - such as antipsychotics and antidepressants - in older people has long been of concern, particularly among those who are in nursing homes. A recent UK Parliamentary report expressed concern that their `inappropriate use' in care homes was a 'means of controlling patients'. There have also been recommendations that there should be a reduction of use of antipsychotic drugs in older people with dementia across the UK.
The new study shows that approximately 1 in 6 older people receive at least one psychotropic medication in a 2-year period. The figure rises to 2 in 5 among nursing home residents.
However, the study found that the majority of psychotropic drugs used by nursing home residents were started prior to the patient being admitted, and for those who started antipsychotics just prior to admission it was more likely the person would continue to receive the drugs.
"This study presents a complex picture of the prescribing and use of these medicines," said Colin McCowan, Deputy Director of the Health Informatics Centre at the University of Dundee. "Psychotropic drug use is significantly higher in care home residents but they would seem to be initiated primarily before people are admitted.
"This may be evidence against the belief that initiation is largely driven by care home staff to make residents easier or more convenient to manage.
"There may be valid reasons for the initiation of these drugs but prolonged use of psychotropic medication in older people is not recommended and may cause harm. The key issue our study suggests is that there should be systematic medication reviews for patients on these drugs, to highlight drugs that may be discontinued if the reasons for their initial prescription are no longer valid."
The study compared the prescribing of psychotropic medications in Tayside for patients living in care homes to patients living at home. It used data gathered over a two-year period.
Previous research has shown that many of the antipsychotics being prescribed to patients are likely to be having very little beneficial effect, and can be reduced and usually stopped.
Stella Clark, of NHS Fife, said there were some promising signs in prescribing patterns but that national guidance still needed to be developed.
"We have recently seen data for the whole of England which showed a reduction in the prescription of antipsychotics to people with dementia," said Stella.
"This is a really important area of prescribing where changes can be made which will improve patient safety and there is a clear need for national guidance to be developed."
NOTES TO EDITORS
Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life. It is the official scientific journal of the British Geriatrics Society and is published by Oxford University Press.
The British Geriatrics Society (BGS) is a membership association of doctors, nurses, therapists, scientists and others with a particular interest in the care of the frail older person and in promoting better health in old age.
13 Sep 2012
Study calls for reviews of psychotropic medication