A follow-up survey of psychotropic drug use in Sydney nursing homes

J Snowdon
Medical Journal of Australia 1999 April 5, 170 (7): 299-301

OBJECTIVE: To review the pattern of use of psychotropic drugs in Sydney nursing homes.

DESIGN: Repeat survey of data from medication cards.

SETTING: Central Sydney Health Area, February to June 1998.

SUBJECTS: All residents of 38 of the 39 nursing homes in the western sector of the health area.

MAIN OUTCOME MEASURES: Psychotropic drugs used regularly or as required.

RESULTS: In 1998, 48.5% of residents (95% confidence interval [CI], 46.3%-50.7%) were taking one or more psychotropic drugs regularly and another 4.5% (95% CI, 3.6%-5.4%) had been given "as required" doses at least once in the preceding 4 weeks. Corresponding figures in 1993 were 58.9% (95% CI, 56.9%-60.9%) and 7.0% (95% CI, 6.0%-8.0%). A significantly smaller proportion of residents were taking regular doses of neuroleptics (22.6%), hypnotics (17.0%) and anxiolytics (6.2%) than in 1993. Moreover, dosages of conventional neuroleptics (particularly haloperidol) tended to be lower than in 1993, and 2.4% were prescribed new-generation neuroleptics. The proportion prescribed antidepressants was similar to that in 1993, but fewer (40% v. 64%) were given doses regarded as inadequate for treatment of depression; about half were taking the newer antidepressants. Some 13% were taking anticonvulsants, but these were not categorised as psychotropic in the 1993 or 1998 surveys.

CONCLUSIONS: There have been considerable reductions in prescribing of neuroleptic, hypnotic and anxiolytic medication in central Sydney nursing homes. Changes may be attributable to educational initiatives and publicity about perceived overuse.

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