Macquarie study slams excessive use of antipsychotic drugs to control dementia

The call follows the revelation that one in three people living with dementia in residential aged care is chemically restrained through antipsychotic drugs for twice the recommended maximum time.

A Macquarie University study examined 60 facilities with more than 10,000 residents in NSW and the ACT, finding that the liberal use of these drugs was aimed at controlling the behaviour of residents through sedation and impairing cognitive function.

COTA chief executive Ian Yates said the findings were yet more evidence of widespread malpractice by aged care providers and the doctors who prescribed the medication - often without individual consultation or family consent, or in some cases without following clinical requirements.

"This appalling use of chemical restraints is a form of elder abuse, and a breach both of aged care quality standards and medical professional ethics," Mr Yates said.

"Aged care nurses and other staff unqualified to prescribe medication are requesting this medication be prescribed, and doctors who are trained to know better are doing so far too often. For both parties, their first, second and third priorities should be the welfare of the people in their care.

"The Aged Care Quality and Safety Commission and the Australian Commission on Safety and Quality in Health Care also have important roles to play in limiting the overuse of antipsychotic drugs in aged care.

The research by the Australian Institute of Health Innovation revealed shown 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. This included people with other psychiatric conditions (such as psychoses, schizophrenia, depression or anxiety) and those without.

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.

Dr Kim Lind, Research Fellow at the Australian Institute of Health Innovation and lead author said: "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," she said.

Dr Lind says it was essential to measure how long people were using antipsychotic medication to identify inappropriate use of potentially harmful medication.

Risperidone is the most commonly used antipsychotic in the study. It is subsidised by the Australian Medicare Pharmaceutical Benefits Schedule for management of behavioural and psychological symptoms of dementia.

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