Antipsychotic drugs overused in aged care

ONLY 10 per cent of “chemical restraint” drugs prescribed to people with dementia in residential aged care facilities are clearly justified, a royal commission has heard.

Australia’s chief medical officer Brendan Murphy said regulation alone will not solve the problem of the overuse of antipsychotic drugs.

An expert committee this year found the rate of prescription of antipsychotics is too high, the aged care royal commission heard on Tuesday.

The aged care clinical advisory committee noted only a small proportion, estimated at about 10 per cent of the current use, is clearly justified.

Professor Murphy said it was an anecdotal assessment from experts in the field.

“The sense was that in their clinical experience, in probably eight to nine out of 10 cases you probably didn’t need and shouldn’t be using those drugs, so it was merely an estimate, a guesstimate.”

He said requests from aged care facility staff were one of the common reasons GPs were asked to prescribe drugs to modify behaviour, when they felt it was causing distress to the person or other residents.

Prof Murphy said the overuse of psychotropic drugs in residential aged care facilities had been an international problem for 20 years.

New quality standards come into effect on July 1 to better regulate and minimise the use of chemical and physical restraints in aged care homes, an issue also being examined by the new national aged care regulator.

Asked about the delay in the government clearly setting limitations around the use of antipsychotics, Prof Murphy said regulation was only part of the solution.

“The best way to influence the prescribing behaviour of general practitioners working in aged care is education and cultural change, making them aware of the fact that the prescription of these drugs is not beneficial.

“Most of the inappropriate prescribing is not done with malicious intent to restrain someone.

“It’s done because the general practitioner believes it might help in the management of the symptoms, and they’re not fully aware of the adverse consequences.”

There is no direct data about the number of prescriptions of psychotropic drugs to people living with dementia in residential aged care.

The royal commission on Tuesday also heard calls from aged care providers to change the funding structure to encourage innovation and good practice.

“If we look at the way the industry is structured, if I might put it very simply, we are funded for the amount of medications we’re giving, how many times we shower someone, what meals we provide,” Glenview CEO Lucy O’Flaherty said.

“We’re not funded for how happy a resident is and how we’ve reduced their sleep medication because they’re happier and sleeping better.”

Brightwater Care Group CEO Jennifer Lawrence said there should be incentives for providers for helping people lead a good life and be as independent and well for as long as possible.