Antipsychotic use in aged care ‘not ideal’

Aged care patients are being treated with antipsychotics at a rate that is at least double the level of psychosis diagnoses, according to new data.
 
The Australian Institute of Health and Welfare (AIHW) has released its latest Residential Aged Care Quality Indicators – January to March 2024 data, revealing that 18% of patients use antipsychotic medication, while the rate of antipsychotic use with a psychotic diagnosis is just 9%.
 
Separately, the latest results from the AIHW Mental Health in Aged Care report show 4.1% of people aged 65 years and over had a psychotic disorder recorded on their aged care assessment.
 
Professor Dimity Pond, a GP with a special interest in aged care, said ‘the use of antipsychotics is far from optimal’.
 
Professor Pond says that much of the prescribing of antipsychotics can be attributed to dementia, which is not classified as a psychosis.
 
‘There’s a good reason for it, but it’s not ideal,’ she told newsGP.
 
She says medication is often used in place of human contact that could sooth agitated patients.
 
‘I would point the finger at the fact that the alternative for agitation, and crying, and so on in dementia is quite concentrated on nursing care,’ she said.
 
‘There’s not enough staff, and there aren’t enough staff because these facilities can’t afford it, and that’s because the Government limits how much money goes per person.
 
‘That doesn’t leave enough money to pay for a large number of staff to look after people.’
 
Professor Pond has patients herself that she has had to give antipsychotics as the logistics of their care situation means that they cannot get the support they need in person.
 
‘This patient was crying at night and missing her husband when she first moved in, and she was fine if the nurse would sit with her for five minutes at night, and she would settle,’ she said.
 
‘But the thing is, there’s only one nurse on in a ward of more than 30 people, and she couldn’t spend five minutes every hour with my patient.’
 
Polypharmacy in aged care is also at 34.6%, with 63,183 people on nine or more medications.
 
But people with dementia, which Professor Pond says is more than 50% of patients, often have multiple comorbidity issues.
 
‘People with dementia have an average of five other chronic diseases, and all of those might require medications,’ she said.
 
‘We’re supposed to deprescribe as a person gets older, where we look at what they’re on, and we think about their life expectancy, and we reduce their medications, but it’s a very challenging thing to do.
 
‘You know that you’re gradually removing supports for that person’s physical health, and you need to discuss it with the relatives and so on, so there’s a time, resource, funding and ethical issues around all of that.’
 
Professor Pond ties these issues back to a lack of support and remuneration for GPs putting in excessive hours of unpaid work.
 
‘There’s an awful lot of discussions needed that we can’t charge for,’ she said.
 
‘The amount of work that you must put in to be a GP in residential aged care, and the amount of distress around it, the difficult issues and the amount of time you have to spend on unpaid parts of that work, the remuneration is not sufficient.
 
‘I think it’s unsustainable, unless we can find some other model or more money.’
 
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