Antipsychotic meds over used in aged care
New research by the Australian Institute of Health Innovation at Macquarie University, shows that many people with dementia living in residential aged care facilities are being treated with antipsychotic medication for an average of twice as long as the recommended maximum time, increasing the risk of stroke.
The research showed that 65% of people with dementia in the residential aged care facilities studied who were treated with antipsychotics, remained on the medication for longer than the recommended maximum 12-week duration. This included people with other psychiatric conditions (such as psychoses, schizophrenia, depression or anxiety) and those without.
This is the first large longitudinal study of the duration of use of antipsychotic medication for the care of people with dementia in residential aged care facilities in Australia, and the first to use actual duration of medication used measured by medication administration records.
In line with the Royal Commission into Aged Care Quality and Safety’s statement on underperforming medication management as a leading concern, Dr Kim Lind, Research Fellow at the Australian Institute of Health Innovation and lead author states that antipsychotic medication management is a prime example of where systematic monitoring of adherence to medication guidelines could quickly improve the care of our most vulnerable people.
The research looked at the electronic health records and medication administration records for 5825 people aged 65 years and over with dementia living in 68 residential aged facilities in NSW and ACT between 2014 and 2017.
Guidelines recommend the short-term, maximum 12 week, use of antipsychotic medication for behavioural and psychological symptoms of dementia only when other strategies have failed.
Antipsychotic medications remain widely used in dementia despite their modest effects on behavioural and psychological symptoms of dementia and serious risks they carry. Paired with research published earlier this year that showed potentially beneficial antidementia medications (cholinesterase inhibitors and memantine) are underused in Australian residential aged care, this new study shows that care for people with dementia can be improved.
Australia has a high use of antipsychotic medication for people with dementia, and this rate is highest for people in residential aged care facilities.
High use of antipsychotics in dementia is an international problem. For people with dementia living within the community, an estimated 12% are treated with antipsychotic medication; this increases to 38% for all people living in residential aged care.
Dr Lind said it is essential to measure how long people are using antipsychotic medication to identify inappropriate use of potentially harmful medication.
"Our Research shows that people with dementia are on antipsychotic medication for roughly twice as long as the recommended maximum time to treat behavioural and psychological symptoms of dementia.”
Risperidone was the most commonly used antipsychotic in this study and it is subsidised by the Australian Medicare Pharmaceutical Benefits Schedule for management of behavioural and psychological symptoms of dementia. The current criteria for prescribing this medication is that the patient has Alzheimer’s type dementia, and their symptoms have not improved with other non-pharmacological treatments. Also use of risperidone must be limited to 12 weeks.
Dr Lind would like to see residential aged care facilities supported in their efforts to use methods other than medication to care for people with dementia combined with effective medication management, and also supported in developing new approaches to monitoring medication use.
“Maximising the use of information in electronic health records would assist aged care providers to monitor medication use patterns to ensure patients are not on medication longer than recommended and put at risk of stroke,” she said. “Currently, the data entered daily into electronic systems at facilities are not being fully used as a tool for monitoring and improving care”.
Reference: "Duration of Antipsychotic Medication Use by Aged Care Facility Residents with Dementia" , in Alzheimer Disease and Associated Disorders, https://journals.lww.com/alzheimerjournal/Abstract/publishahead/Duration_of_Antipsychotic_Medication_Use_by_Aged.99345.aspx; doi: 10.1097/WAD.0000000000000336
11 September 2019.