Changes to psychotropic medications in the six months after admission to nursing homes in Melbourne, Australia

Abstract

Judging from epidemiological data, treatment revisions were almost certainly insufficient to address residents' mental health needs. We discuss ways of harnessing existing nursing and pharmacy resources to ensure better care for aged residents.

Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units

“…One study found that people received psychotropic drugs over at least one year despite uncertainty about symptom improvement and another study showed that most antipsychotic prescriptions remained unchanged over a six-month period [17,18]. In the present study, 63/111 (57%) received exactly the same antipsychotic dose after six months.…”

“…Selbæk et al also demonstrated that most symptoms show an intermittent course which does not support long-term treatment with antipsychotics [18]. O’Connor et al discuss the fact that the person’s symptoms are classified as present when in reality they occur only occasionally [17]. These findings stress the importance of reviewing antipsychotic use regularly to ensure that the indication remains.…”

“…According to the Swedish Medical Products Agency, the dose should initially be low and then titrated upwards and treatment should be time-limited and regularly reviewed [1]. Only two recent studies have described long-term antipsychotic treatment among people with dementia [17,18] and both found relatively high rates of long-term treatment. There is still a need for detailed study of the long-term use of antipsychotic in this population.…”

Psychotropic Medications and the Transition Into Care: A National Data Linkage Study

“…29 In reality, despite regular warnings and recommendations to the contrary, the high use of psychotropic medications remains resistant to change. An increase in the need for medication on entry to care might be expected given the increased disorientation and confusion of some older adults during this transition, but this should stabilize in time.…”

Specialist mental health consultation for depression in Australian aged care residents with dementia: a cluster randomized trial

“…There is a high prevalence of depression in aged care residents with dementia (e.g., McCabe et al ., ), and recent Australian surveys point to an inadequate approach to the management of depression in this setting (McSweeney and O'Connor, ; O'Connor et al ., ). McSweeney and O'Connor () found that, whereas 83% of residents with major depression and dementia eventually received antidepressant medication during their study, up to 42% continued to satisfy diagnostic criteria for major depression at 6‐month follow‐up, despite treatment.…”