Study finds trend towards unusual and abnormal prescribing patterns in aged-care homes

Researchers from the Flinders University College of Medicine and Public Health have found that one-quarter of Australian aged-care home residents are nine times more likely to be prescribed antipsychotic drug risperidone.

The Rehabilitation, Aged and Extended Care research group found that dementia patients in nursing homes across South Australia, New South Wales and Western Australia are being heavily prescribed the dangerous drug.

Dr. Craig Whitehead, Clinical Director of the Department of Rehabilitation, Aged and Palliative Care at Flinders Medical Centre, said the study found a trend towards unusual and abnormal prescribing patterns.

“If you’re a GP and you’ve got someone with a behavioural problem, you only have limited options,” he said.

“I think it does raise the question about how do we educate and skill our nursing and medical workforce to actually really become skilled in caring for this honourable group of people.”

Collaborating with the National Health and Medical Research Council (NHMRC), the study investigated data from the individual pharmacy records of 541 residents from 17 nursing homes. Of those records, 64.3 per cent (348) had dementia and 193 did not.

Dr. Whitehead said that while it was already known that risperidone is used heavily for people with dementia, the study confirmed it is primarily prescribed in aged care homes.

“You are nine times more likely to be on that drug if you have dementia than if you don’t.”

Dr. Whitehead said that the drug poses an increased risk to older people the longer they take the medication, including an increased risk of falls, blood clots and even death.

“Risperidone does increase the risk of death, it increases the risk of stroke if you take it longer than 12 weeks – even as early as 12 weeks,” Dr. Whitehead said.

“That risk increases the longer you take it.”

The drug is mainly used to treat behaviour in dementia patients, like aggressive or agitated behaviour towards other people or aged care workers.

“Risperidone is indicated for changed or challenging behaviour in dementia. At its most severe form, that will be for aggression to other people or staff members, or severe agitation where the person is very upset,” he said.

“Part of the reason risperidone gets such a bad name is because it’s the best studied drug and so we actually know what its risks are. While risperidone may be bad, alternatives may also be bad. We just don’t know.”

The study of hundreds of residential nursing homes also found that more advanced dementia patients are more likely to be medicated for urinary tract infections which is another sign of reduced awareness and communication of the needs of these residents.

“While we can’t be certain of the reasons for this difference, it is possible that greater confusion or worsening cognition in residents with dementia is sometimes being attributed to urinary tract infections, prompting an increase in treatment and testing,” said Dr. Whitehead.

“Awareness by clinicians and pharmacists of these patterns of medication use could improve management of this vulnerable population.”

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