Introduction

Mental disorders are prevalent in a large proportion of the care home population; the prevalence of mental impairment among nursing home residents in Norway has been reported to be as high as 80%¹. Therefore, a high usage of psychoactive medication (hypnotics, anxiolytics, antipsychotics and antidepressants) is to be expected. Nevertheless, psychoactive medication is associated with the majority of medication-related problems in care home residents, therefore these medicines should be used judiciously.

Method

A convenience sample of 19 care homes across Northern Ireland was chosen. Consent to access charts within the care homes and the GP's surgery was sought from either the resident personally or their next-of-kin. Information regarding medication was gathered from the documentation available within the care homes, whereas information regarding the diagnoses were collected from records within the GP surgery or supplied by the GP. All data were classified according to the BNF and entered into a MS-Access database.

Results

A total of 794 residents were invited to participate in the research project, and 462 (58.2%) consented. Thirty-four residents died prior to medication review, therefore information regarding current medication was collected for 428 residents (103 male and 325 female; mean age 84 years; mean number of medicines prescribed 8.5). In total 312 (72.8%) residents were being prescribed psychoactive medication (including 'prn' drugs). Ninety-six residents were being prescribed 2 psychoactive drugs concurrently and 43 residents, 3 or more drugs concurrently. More than 30% residents were being prescribed hypnotics, antipsychotics and antidepressants respectively. Of all residents using psychoactive medication, 37 (11.9%) were prescribed a dosage only recommended in exceptional circumstances for the elderly or a dosage lower than recommended. Additionally, 42 (13.5%) residents were prescribed drugs with prolonged action (hypnotics) or pronounced sedative side effects (antipyschotics). Table 1 highlights that suitable diagnoses (according to the BNF) were recorded for only 21% residents prescribed psychoactive medication.

Table1 Number of residents with recorded suitable diagnoses for psychoactive medication

*based on the BNF 42

Discussion

Previous researchers have reported prescribing rates for psychoactive medication for around 60% nursing home residents^2,3; therefore the overall prescribing rate for psychoactive medication of 73% is surprisingly high. However, the prescribing rates of hypnotics, antipsychotics and antidepressants are very similar to a recent RCT carried out in nursing homes in Manchester⁴. Within each category of psychoactive medication there seems to be a surprisingly high number of residents being prescribed drugs which are not necessarily deemed suitable for the elderly. Additionally, only one in five residents had a suitable diagnoses recorded in their charts. The medicines prescribed may well be indicated for the residents; however, these results suggest that record-keeping is incomplete and use of psychoactive medication is high, raising the issue of poor risk management in prescribing.

References:

1 Nygaard H A, Bakke K, Breivik K & Brudvik E. (1990) International Journal of Geriatric Psychiatry 5, 308

2 Draper B, Brodaty H, Low L F, Saab D, Lie D, Richards V & Paton H. (2001) International Psychogeriatrics 13, 107-120

3 Ruths S, Straand J & Nygaard H A. (2001) European Journal of Clinical Pharmacology.57(6-7):523-8

4 Furniss L, Burns A, Craig S K, Scobie S, Cooke J & Faragher B. (2000) British Journal of Psychiatry 176, 563-567