Psychotropic drug prescribing in residential aged care homes

Individualised psychosocial interventions are needed as alternatives to pharmacological sedation

Sedating psychotropic drugs, including antipsychotics and benzodiazepines, are commonly prescribed in residential aged care facilities (RACFs), despite extensive evidence of their limited efficacy for treating behavioural and psychological symptoms in older people and of their potential for eliciting serious adverse effects, including death.1 As a consequence, efforts are afoot in many countries to minimise the use of these medications in RACFs. In this issue of the MJA, Westbury and colleagues2 report findings from the RedUSe study of a multi-component intervention designed to reduce the prescribing of sedative medications in Australian RACFs. This uncontrolled investigation employed four complementary interventions in 150 nursing homes: psychotropic medication audits by a local champion nurse; RACF staff education sessions conducted by a pharmacist using benchmarked local data and incorporating training in non-pharmacological interventions; interdisciplinary prescribing reviews for each RACF resident; and academic detailing for prescribers. This intervention sequence was repeated twice, 3 months apart. Data for 12 157 RACF residents collected at baseline, 3 months and 6 months indicated that prescribing of antipsychotics and benzodiazepine had decreased significantly following the intervention: the prevalence of antipsychotic use dropped from 21.6% of residents at baseline to 18.9% at 6 months, and that of benzodiazepines from 22.2% to 17.6%. For 39% of RACF residents taking antipsychotics or benzodiazepines at baseline, medication was ceased or the dosage reduced at 6 months.