Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study

Abstract

Background: Psychotropic medications have been associated with many adverse outcomes in older people living in residential care. Home-like models of residential care may be preferable to traditional models of care and we hypothesized that this model may impact on the prevalence of psychotropic medications. The objectives were to: 1) examine associations between psychotropic medications and quality of life in older adults living in residential care facilities with a high prevalence of cognitive impairment and dementia and 2) determine if there was a difference in prevalence of psychotropic medications in facilities which provide a small group home-like model of residential care compared to a 'standard model' of care. Methods: Participants included 541 residents from 17 residential aged care facilities in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses were completed to examine the above objectives. Quality of life was measured with the dementia quality of life questionnaire (DEMQOL) and the EQ-5D-5L completed by the resident or a proxy. Results: Overall, 70.8% (n = 380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. An increased number of psychotropic medications was associated with lower quality of life according to DEMQOL-Proxy-Utility scores (β (SE): − 0.012 (0.006), p = 0.04) and EQ-5D-5L scores (− 0.024 (0.011), p = 0.03) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with lower DEMQOL-ProxyUtility scores (− 0.030 (0.014), p = 0.03) and benzodiazepines were associated with lower EQ-5D-5L scores (− 0.059 (0.024), p = 0.01). Participants residing in facilities which had a home-like model of residential care were less likely to be prescribed psychotropic medications (OR (95% CI): 0.24 (0.12, 0.46), p < 0.001). Conclusions: An increased number of psychotropic medications were associated with lower quality of life scores. These medications have many associated adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care. Home-like models of residential care may help to reduce the need for psychotropic medications, but further research is needed to validate these findings.

Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

“…A more recent study in Australia (n= 322,120) found that 50% of the participants had a diagnosis of dementia, and the prevalence of antipsychotic dispensing was 21.3%, benzodiazepines 30.5% and antidepressants 38% [34]. Comparing to above two larger studies [33,35], the prevalence of psychotropic medicines was higher in our study (antipsychotics and benzodiazepines 39% and antidepressants 42%). This ndings in our study is not surprising as all the participants recruited in our study are those having advanced dementia.…”

Pharmacist‐led medication reviews in aged care residents with dementia: A systematic review

“…These are key indicators of medication use quality, given the well-documented risk of harm associated with these medicines, the high prevalence of dementia and potentially problematic psychotropic agent use in Australian RACF. 29,30 Reducing the number of prescribed medications was a similar outcome reported in a recent systematic review evaluating outcomes of medication reviews in RACF residents both with and without dementia. 36 Multi-faceted interventions, inclusive of collaborative pharmacist-led medication reviews in residents both with and without dementia, have demonstrated efficacy in reducing inappropriate psychotropic medication use.…”

“…28,29 Psychotropic drug use in residents with dementia is associated with reduced quality of life and increased adverse outcomes, including stroke, falls, hospital admissions and mortality. 30 Medication reviews aim to improve quality use of medicines and reduce the risk of adverse events. 31 Quality use of medicines refers to 'best-possible' medicines use where treatment benefits are maximised, and risk of associated harms is minimised.…”

Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults

“…Low quality of life has been documented as prevalent among African Americans [ 59 , 60 , 61 , 62 ]. Harrison and colleagues (2018) found that an increased number of psychotropic medications in individuals was associated with poorer self-rated health and quality of life [ 63 ].…”