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Government set to tackle overuse of neuroleptics

More than four in five nursing home residents are being

prescribed inappropriate anti-psychotic drugs, new research suggests.

The findings have prompted calls for GPs to resist pressure from nursing home staff to prescribe the drugs unnecessarily.

The Department of Health said it planned to tackle the overuse of anti-psychotics through new minimum standards for GP management of medication in nursing home residents.

The findings came from a review of neuroleptic prescribing in 934 nursing home patients from 12 homes in the South Thames region.

Of the 225 residents on neuroleptics, 82 per cent were on therapy considered inappropriate for one or more reason, with 62 per cent of prescriptions written for an inappropriate indication.

There had been no attempt to reduce dosage in 68 per cent, and 24 per cent of prescriptions could be given 'as required'. Unlimited use was permitted by 5 per cent.

Some 60 per cent of those on the drugs had side-effects, according to a report in Age and Ageing (February).

Study leader Alice Oborne, research fellow in clinical age research at Guy's, King's and St Thomas' School of Medicine in London, said: 'GPs are in a difficult situation because prescribing is not entirely led by GPs on these drugs. Things like the use of sedatives may be at least partially influenced by nursing home staff.'

The data related to prescribing in 1998.

Dr Arnold Zermansky, author of an NHS Health Technology Assessment on medication review, said the situation had improved but GPs still faced a 'very real dilemma' when deciding whether to prescribe neuroleptics.

'You end up being pressured to prescribe not directly to help the person whose behaviour is aberrant but to help those people they live with,' said Dr Zermansky, a GP in Leeds.

GPC prescribing chair Dr Peter Fellows said inadequate care home staffing had fuelled the problem. 'It's all very well saying we shouldn't use sedatives in the confused elderly, but in practice it's not always possible.'

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