Study shows psychotropic drug dispensing increases on entry to care homes

A study by Queen's University Belfast has found that the dispensing of psychotropic drugs to older people in Northern Ireland increases on entry to care homes.

According to the study, due to be published in the Journal of the American Geriatrics Society, antipsychotic drug dispensing in older people more than doubled from 8.2 per cent before entry to care homes to 18.6 per cent after entering care.

The study was carried out by researchers from Queen's Centre for Public Health in the School of Medicine, Dentistry and Biomedical Sciences. It analysed prescribing data for over 250,000 people, aged 65 years and over living in Northern Ireland from 2008 to 2010, and looked at drug uptake within the older population during the transition from community to care.

The study revealed that psychotropic drug use was higher in care homes than the community, with 20.3 per cent of those in care homes dispensed an antipsychotic in January 2009, compared with 1.1 per cent of those in the community.

Lead researcher on the Queen's study, Aideen Maguire, who is based in the Centre of Excellence for Public Health Northern Ireland said: "Although drug dispensing is high in older people in the community, we have found that it increases dramatically on entry to care. This study showed that the high uptake of psychotropic drugs observed in care homes in Northern Ireland cannot be explained by a continuation of drug use initiated in the community prior to entering care.

"With an ageing population globally it is important that we look at the reasons behind this type of increase following admission to care. Antipsychotic uptake in Northern Ireland is similar to that in the rest of the UK and Ireland, and this study highlights the need for routine medicines reviews especially during the transition into care."

Other key findings of the study included:

• Of the 250,617 people studied, 6,779 (2.7 per cent) experienced a transition into care during 2008-2010.
• The psychotropic drugs prescribed to patients included in the study were being prescribed for the first time for many.
• Six months after admission, 37.1 per cent of all new residents had received at least one prescription for a hypnotic drug, 30.2 per cent for an antipsychotic, and 24.5 per cent for an anxiolytic.
• 1.1 per cent of those living in the community were dispensed at least one prescription for an antipsychotic in January 2009, (7.3 per cent for a hypnotic, and 3.6 percent for an anxiolytic).
• Hypnotic drug dispensing increased from 14.8 per cent to 26.3 per cent after entering care.
• This study shows that use of psychotropic medication in a small proportion of residents of care homes was a continuation of a prescription that had been started before entry, but one in six individuals with no history of psychotropic drug use in the six months before entry had been exposed to at least one antipsychotic prescription within six months of entering care.

Professor Carmel Hughes from the School of Pharmacy at Queen's added: "This is an important study of national and international relevance, as with an ageing population, quality of care for older people is an ongoing public health concern.

"The number of older people entering care across Ireland is predicted to increase in the next 10 years, and studies further predict a 69 per cent increase in the Irish population aged over 65 years from 2006-2021, and a 40 per cent increase in the those aged over 65 years in Northern Ireland in the same time frame. With a globally ageing population, it is vitally important that we look at the reasons behind the increase in the prescription of psychotropic drugs in care homes."