Belfast-based researchers compared prescribing data on patients aged 65 years or over in care homes or the community for antipsychotics, hypnotics and anxiolytics using the Enhanced Prescribing Database, a collection of all prescriptions dispensed in pharmacies across Northern Ireland. Follow-up lasted for two years.
Of the 228,394 subjects featured in the analysis, those living the in the community throughout the two year follow-up had a much lower use of all psychotropic drugs, compared with those in care homes. After one year, just over 1% were prescribed an antipsychotic, 7.3% a hypnotic and 3.65 an anxiolytic. By comparison, 20.3% of those in care homes were dispensed an antipsychotic, 24.9% a hypnotic and 9.9% an anxiolytic. Patients who started in the community, but then moved into a care home during the second year, were more than two times likely to be prescribed an antipsychotic drug, compared with those who did not move into a care home.
What does it mean for GPs?
The authors noted that a ‘continuation of drug use before entry cannot fully explain the greater use of psychotropic drugs in care homes, so a focus on reducing prescribing in this specific population is warranted,’ adding that ‘the sharp increase in psychotropic drug dispensing on entry and in the two months after entry to care homes suggests that interventions to reduce drug initiation should target this critical period.’
Journal of the American Geriatrics Society 2013, available online 15 January 2013 – http://onlinelibrary.wiley.com/doi/10.1111/jgs.12101/abstract