Abstract
Aims and MethodTo determine the prescribing patterns for antipsychotics in care homes for the elderly, a cross-sectional study was carried out using data from the intervention group of a randomised controlled trial of medication review in care homes.ResultsOf 331 residents studied, 67 (20%) were prescribed an antipsychotic (70% atypical); 57 of these (85%) did not have a diagnosis of a psychotic disorder. The antipsychotic prescribing rate was 32% (46 out of 146) for those with dementia and 10% (17 out of 174) for those without dementia. A quarter (82 out of 331) had received a medication review by the general practitioner in the preceding 12 months.Clinical ImplicationsOne-fifth of residents were prescribed an antipsychotic with little evidence of review. Systems should ensure residents' treatment is reviewed regularly.
Highlights
The use of antipsychotics by care home residents has been of concern for many years
In the USA, the prescription of antipsychotics to up to 55% of nursing home residents led to the introduction, in the Omnibus Reconciliation Act 1987, of legal restrictions on the use of these drugs (Lee et al, 2004)
An increased risk of ischaemic stroke has been associated with atypical antipsychotic use in elderly patients with dementia (Medicines and Healthcare Products Regulatory Agency, 2004), and this led the Committee on Safety of Medicines to issue guidance that risperidone and olanzapine should not be used for treating behavioural symptoms of dementia
Summary
Of 331 residents studied, 67 (20%) were prescribed an antipsychotic (70% atypical); 57 of these (85%) did not have a diagnosis of a psychotic disorder. In the USA, the prescription of antipsychotics to up to 55% of nursing home residents led to the introduction, in the Omnibus Reconciliation Act 1987, of legal restrictions on the use of these drugs (Lee et al, 2004). Many of the residents of these homes have Alzheimer’s disease or other forms of dementia, and treatment of behavioural and psychological symptoms of dementia may be one reason for use of these drugs. An increased risk of ischaemic stroke has been associated with atypical antipsychotic use in elderly patients with dementia (Medicines and Healthcare Products Regulatory Agency, 2004), and this led the Committee on Safety of Medicines to issue guidance that risperidone and olanzapine should not be used for treating behavioural symptoms of dementia. The aim of this study was to determine the prescribing patterns of antipsychotics in care homes for the elderly since the restrictions on thioridazine
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