Research leads to psychotropic medication reduction in aged-care facilities
Effective intervention can reduce medication overuse in residential aged care facilities (RACFs), the latest University of Tasmania research shows.
Led by the Wicking Dementia Research and Education Centre’s Dr Juanita Westbury, the research published in the Medical Journal of Australia (MJA) recently focuses on the results of the RedUSe (Reducing Use of Sedatives) intervention aimed at reducing the use of psychotropic medications (mainly antipsychotic and benzodiazepine medications) in RACFS around the country.
After an initial trial in Tasmania, Dr Westbury introduced the RedUSe multi-strategic intervention nationally to more than 12,000 aged-care residents in 150 RACFs.
During the project, each RACF’s sedative medication use was measured initially, then at three months and finally at six months. Nursing and care staff attended training sessions on psychotropic medication and residents taking these medicines were reviewed by nursing staff, pharmacists and their GP.
The rates of reduction in the use of and response rate for psychotropic medications is shown in the executive summary of the report:
"At baseline we found that over a third of residents (37%) were taking a sedative medication daily.
"Specifically, 22% were taking an antipsychotic and 22% of residents were taking a benzodiazepine. With ‘prn’ or ‘as required’ prescriptions included, over half of all RACF residents (54%) were prescribed a sedative agent.
"Throughout RedUSe, antipsychotic and benzodiazepine use in each of the 150 RACFs was measured at baseline and then re-measured at three and six months, with 12,153 residents, on average, included at each time point.
"Overall, a significant reduction was found in antipsychotic and benzodiazepine use. A 13% relative reduction was observed in the prevalence of antipsychotics from baseline to 6-months (from 22% to 19% of residents). The reduction in benzodiazepine prevalence was higher; at 21% (from 22% to 17.5%).
"The reduction was also sustained over time: Over 80% of antipsychotic agents, and 90% of benzodiazepines ceased or reduced at three months, remained reduced when residents were re-checked at sixmonths.
"A quarter of residents who had their sedative dose reduced at threemonths, were ceased altogether by the sixmonth audit. A total of 115 RACFs (77%) reduced their antipsychotic use prevalence, with 127 of the RACFs (85%) reducing benzodiazepine use. Out of 150 RACFs, two-thirds of the facilities (66%), reduced both antipsychotic and benzodiazepine prescribing rates."
Dr. Westbury spoke to Norman Swan on ABC Radio’s Health Report recently, where she spoke to many elements of the research including the amount of patients that were using sedatives in aged care facilities and the range of effects that they were having on these patients. A full copy of the interview can be found below.
The study not only looked at trialling a reduction in sedative use but also looked at implementing more exercise and meaningful activities as replacements for the medication, explained Dr. Westbury on Win News Tasmania on Monday the 14th of May, 2018 (https://www.facebook.com/WINNewsTasmania/videos/1918414501525547/).
The key recommendations of Dr Westbury’s research included making RedUSe available to all Australian RACFs in the future and for the program to be offered as part of the Federally funded ‘Quality Use of Medicines’ program for community pharmacists.
The research also recommended the provision of national training for RACF staff to manage behavioural and psychological symptoms of dementia and in alternatives to medication for the treatment of these symptoms.
To find out more, download:
- The RedUSe Executive Summary (310.9 KB)
- An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project (430.6 KB)
- More action needed: Psychotropic prescribing in Australian residential aged care (371.2 KB)
For a full copy of the report, please contact:
Dr Juanita Westbury
Senior Lecturer Dementia Studies
Wicking Dementia Research and Education Centre
Private Bag 143, Hobart
Tasmania, Australia 7001
18 May 2018.