Sydney researchers have revealed people with dementia who change their GP when they enter aged care are more likely to be given higher doses of medication - specifically antipsychotics, benzodiazepines and antidepressants, than those who retain their usual GP.
"We already knew there were high levels of psychotropic medicine prescribing in residential aged care, in particular, medicines like antipsychotics and benzodiazepines," said Heidi Welberry from the Centre for Big Data Research in Health, UNSW Sydney.
"There's a big uptick in prescribing just after entry to residential aged care. We also know anecdotally that many people change GP when they go into residential care. So, what we looked at was whether this increase in prescriptions was related to a change in their usual GP."
The research analysed data from 2250 new residents with a dementia diagnosis prior to entering residential care between January 2010 and June 2014 from the Sax Institute's 45 and Up Study in New South Wales.
Prior to this research, little was known about how many residents changed their GP when they entered aged care facilities, or what effect this had on their care.
Of the 2250 new residents with dementia, just over a quarter (28 per cent) retained their usual GP, over a quarter (29 per cent) changed to another known GP (that is a GP they had seen before but not their usual GP) and nearly half (44 per cent) saw a new GP.
Residents seeing a new GP were dispensed 20 per cent more medicines - including antipsychotics and benzodiazepines - than residents who retained their usual or known GP.
Polypharmacy in older people can increase the risks of medication errors and hazardous interactions. The expected benefits of antipsychotics and benzodiazepines for older people with dementia is small and the risk of adverse effects high.
Professor Henry Brodaty, one of the co-authors of the study said, "There's an increased risk in adverse events like stroke, and death among older people with dementia taking antipsychotics. So generally, the recommendation is to try other strategies first to help manage changed behaviours and psychological symptoms associated with dementia. This could include diversion therapy and music therapy."
The research highlighted the pressure aged care systems are under around the world due to ageing populations and the increasing prevalence of dementia. During the Australian Royal Commission into the Quality and Safety of Aged Care, inappropriate medicine use was among the problems scrutinised, particularly the use of antipsychotics and sedatives as chemical restraints.
The Royal Commission into Aged Care noted that pharmacologically restraining patients can arise from a "lack of knowing the person as an individual person".
Professor Louisa Jorm, another co-author, acknowledged a change in prescriptions for people entering residential care may reflect events that precipitated their entry or their adjustment to their new surroundings. For people with dementia, a new environment can be distressing, and the impact can be exacerbated by having an unfamiliar GP.
"New GPs who already see many patients in the residential care facility may possibly be influenced a bit more by the residential aged care staff as opposed to those who know their patients and families better. But this is something we don't know. This study has raised a lot of questions about what may drive changes in prescribing patterns," said Dr Welberry.
Dr Welberry said she hopes this study forms part of the discussion around what a high-quality model of GP care in aged care looks like.
"We would also like to understand more about some of the drivers behind prescribing in terms of how these might differ among these different GP groups.
The study was published in the Medical Journal of Australia.
