Abstract
BackgroundPsychotropic medications have been associated with many adverse outcomes in older people living in residential care. Home-like models of residential care may be preferable to traditional models of care and we hypothesized that this model may impact on the prevalence of psychotropic medications. The objectives were to: 1) examine associations between psychotropic medications and quality of life in older adults living in residential care facilities with a high prevalence of cognitive impairment and dementia and 2) determine if there was a difference in prevalence of psychotropic medications in facilities which provide a small group home-like model of residential care compared to a ‘standard model’ of care.MethodsParticipants included 541 residents from 17 residential aged care facilities in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses were completed to examine the above objectives. Quality of life was measured with the dementia quality of life questionnaire (DEMQOL) and the EQ-5D-5L completed by the resident or a proxy.ResultsOverall, 70.8% (n = 380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. An increased number of psychotropic medications was associated with lower quality of life according to DEMQOL-Proxy-Utility scores (β (SE): − 0.012 (0.006), p = 0.04) and EQ-5D-5L scores (− 0.024 (0.011), p = 0.03) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with lower DEMQOL-Proxy-Utility scores (− 0.030 (0.014), p = 0.03) and benzodiazepines were associated with lower EQ-5D-5L scores (− 0.059 (0.024), p = 0.01). Participants residing in facilities which had a home-like model of residential care were less likely to be prescribed psychotropic medications (OR (95% CI): 0.24 (0.12, 0.46), p < 0.001).ConclusionsAn increased number of psychotropic medications were associated with lower quality of life scores. These medications have many associated adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care. Home-like models of residential care may help to reduce the need for psychotropic medications, but further research is needed to validate these findings.
Highlights
Psychotropic medications have been associated with many adverse outcomes in older people living in residential care
Psychotropic medications include antipsychotics, antidepressants and benzodiazepines and these are commonly prescribed to older people in residential settings, those with dementia, to manage behavioural and psychological symptoms of dementia (BPSD), despite limited evidence of efficacy in this setting and their known potential serious adverse effects [4, 5]
Characteristics of the participants The mean (SD) age of the participants was 85.5 (8.5) years old and 74.5% (n = 403) were female (Table 1). These figures are comparable with characteristics of those residing in permanent aged care in Australia, where the average age is 84.5 years old and 69% are female [25]
Summary
Psychotropic medications have been associated with many adverse outcomes in older people living in residential care. People who live in residential aged care facilities are more likely to experience a reduced quality of life compared to those living in the community [2]. Psychotropic medications include antipsychotics, antidepressants and benzodiazepines and these are commonly prescribed to older people in residential settings, those with dementia, to manage behavioural and psychological symptoms of dementia (BPSD), despite limited evidence of efficacy in this setting and their known potential serious adverse effects [4, 5]. Advancing age and polypharmacy both increase the risk of these effects [6] Evidence has suggested these medications may be over prescribed in residential aged care facilities in many countries, including Australia [7]. Inappropriate use of psychotropic medications is a particular concern for people living in residential aged care as psychotropic medications have been associated with increased risk of falls, hospitalization, stroke and mortality in this population [7]
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