Residential aged care facilities need to tackle antipsychotic usage in dementia patients

NPS MedicineWise has welcomed the recommendations of the recently released Senate Committee report on the care of Australians living with dementia and is encouraging residential aged care facilities to tackle the overuse of antipsychotics medicines in people with behavioural or psychological problems associated with dementia.

NPS MedicineWise CEO Dr Lynn Weekes says that while there is sometimes a need for the use of psychotropic medicines like antipsychotics in residents with dementia, there is evidence to suggest instances where they are being used too often, for too long, and at doses higher than recommended or in potentially dangerous combinations with other medicines.

“Evidence suggests there is extensive off label use of antipsychotics for dementia patients in residential aged care,” says Dr Weekes.

“Antipsychotics should be used with caution and only when the benefits outweigh the risk of harm. Their use, alongside ongoing non-pharmacological management also requires careful monitoring.”

NPS MedicineWise supports the Senate Committee’s recommendation for a three month review by the prescribing doctor to assess the ongoing need for antipsychotic medicines initiated in residents, and the requirement for residential aged care facilities to report circumstances where an individual has been prescribed antipsychotic medication for more than six months.

“Behavioural and psychological symptoms of dementia are often transient and related to environmental factors. Health professionals should review the need for antipsychotics regularly. Clinical improvement would be expected within 12 weeks, and when possible, attempts should be made to gradually withdraw the medicine,” says Dr Weekes.

“NPS MedicineWise has a range of resources and programs to assist residential aged care facilities to improve resident care in line with evidence-based guidelines. For example, we offer a drug use evaluation (DUE) tool for aged care facilities on antipsychotic use for behavioural and psychological symptoms of dementia, as well as monitoring and decision-making tools for antipsychotics.

“Importantly, we’ve also recently collaborated with Webstercare to design a new Quality Use of Medicine (QUM) report to help residential aged care facilities understand and analyse their antipsychotic medicine usage.”

The QUM report flags those patients who have been taking antipsychotics for longer than three or six months, and provides patterns of antipsychotic usage in the residential aged care facility over time. This enables pharmacists to provide information to staff working in residential aged care facilities and aids them in understanding, analysing and effectively managing the appropriate use of antipsychotic medicines for their residents.

“Incorrect use of these medicines can have serious consequences including an increased risk of falls, hip fractures and even death, and so any steps residential aged care facilities can take to ensure their appropriate use would be well worth the investment,” says Dr Weekes.