Abstract
Objectives:
To assess changes in the prevalence of psychotropic medication administration in Australian residential aged care (RAC) during a period of national reforms, including the introduction of mandatory reporting of antipsychotic use.
Design:
A retrospective cohort study using routinely collected electronic medication administration data.
Setting and Participants:
Daily medication administration data for 52,201 residents of 428 RAC facilities in 7 Australian states and territories between January 2018 and December 2022.
Methods:
We estimated the percentage of residents administered psychotropic medications from 4 classes (antipsychotics, sedatives and anxiolytics, antiseizure medication, antidepressants) at least once in each calendar month. The relative monthly average percentage change (RAPC) in prevalence by dementia status was the primary outcome.
Results:
Significant reductions occurred in the administration of antipsychotic, sedative and anxiolytic, and antiseizure medication to residents with and without dementia between 2018 and 2022. Residents with dementia experienced an RAPC of -45.6% (95% CI: 48.3, -36.9; P < .001) for antipsychotics, -40.9% (95% CI: 50.4, -31.4; P < .001) for sedatives and anxiolytics, and -41.0% (95% CI: 49.0, -33.0; P < .001) for antiseizure medication. Residents without dementia experienced an RAPC of -43.8% (95% CI: 50.9, -36.7) for antipsychotics, -36.1% (95% CI: 43.4, -28.9) for sedatives and anxiolytics, and -25.0% (95% CI: 34.4, -18.5) for antiseizure medication. Antidepressant use overall, and for both dementia and nondementia groups, did not significantly change. However, from May 2019, antidepressant administration for residents with dementia rose higher than that for residents without dementia.
Conclusions and Implications:
Between 2018 and 2022, use of 3 psychotropic medication classes declined in Australian RAC. However, antidepressant use may be increasing in people with dementia as a form of chemical restraint. Ongoing monitoring of the national Quality Indicator program and other initiatives is crucial to ensure there are no unintended consequences such as switching between psychotropic medication classes.
To assess changes in the prevalence of psychotropic medication administration in Australian residential aged care (RAC) during a period of national reforms, including the introduction of mandatory reporting of antipsychotic use.
Design:
A retrospective cohort study using routinely collected electronic medication administration data.
Setting and Participants:
Daily medication administration data for 52,201 residents of 428 RAC facilities in 7 Australian states and territories between January 2018 and December 2022.
Methods:
We estimated the percentage of residents administered psychotropic medications from 4 classes (antipsychotics, sedatives and anxiolytics, antiseizure medication, antidepressants) at least once in each calendar month. The relative monthly average percentage change (RAPC) in prevalence by dementia status was the primary outcome.
Results:
Significant reductions occurred in the administration of antipsychotic, sedative and anxiolytic, and antiseizure medication to residents with and without dementia between 2018 and 2022. Residents with dementia experienced an RAPC of -45.6% (95% CI: 48.3, -36.9; P < .001) for antipsychotics, -40.9% (95% CI: 50.4, -31.4; P < .001) for sedatives and anxiolytics, and -41.0% (95% CI: 49.0, -33.0; P < .001) for antiseizure medication. Residents without dementia experienced an RAPC of -43.8% (95% CI: 50.9, -36.7) for antipsychotics, -36.1% (95% CI: 43.4, -28.9) for sedatives and anxiolytics, and -25.0% (95% CI: 34.4, -18.5) for antiseizure medication. Antidepressant use overall, and for both dementia and nondementia groups, did not significantly change. However, from May 2019, antidepressant administration for residents with dementia rose higher than that for residents without dementia.
Conclusions and Implications:
Between 2018 and 2022, use of 3 psychotropic medication classes declined in Australian RAC. However, antidepressant use may be increasing in people with dementia as a form of chemical restraint. Ongoing monitoring of the national Quality Indicator program and other initiatives is crucial to ensure there are no unintended consequences such as switching between psychotropic medication classes.
| Original language | English |
|---|---|
| Article number | 105832 |
| Pages (from-to) | 1-7 |
| Number of pages | 7 |
| Journal | Journal of the American Medical Directors Association |
| Volume | 26 |
| Issue number | 11 |
| DOIs | |
| Publication status | E-pub ahead of print - 26 Aug 2025 |