J Snowdon1. 1. Department of Psychological Medicine, University of Sydney, NSW. jsnowdon@mail.usyd.edu.au
Abstract
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.
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.
Authors: Christopher D Beer; Barbara Horner; Osvaldo P Almeida; Samuel Scherer; Nicola T Lautenschlager; Nick Bretland; Penelope Flett; Frank Schaper; Leon Flicker Journal: Trials Date: 2010-05-26 Impact factor: 2.279