Drugs review urges a role for psychiatrists

Prescription of initial courses of antipsychotic drugs to aged-care home residents could be limited to psychiatrists rather than GPs.

Prescription of initial courses of antipsychotic medication and sedatives to aged-care home residents could be limited to psychiatrists rather than general practitioners if a proposal from the aged-care royal commission is adopted.

In its interim report handed down on Thursday, the royal commission said GPs were poorly trained in management of patients with dementia, and were routinely facilitating the use of chemical restraint in elderly residents.

“General practitioners may have little preparation or training in the management of changed behaviours, and the only strategy at their disposal is the prescription of psychotropic medications to sedate the person,” it said.

The royal commission has heard that as many as one in five aged-care residents are administered antipsychotic medication, 41 per cent are taking antidepressants, and 22 per cent had been prescribed benzodiazepines.

Research shows that physical restraints can cause premature death and other serious physical and psychological consequences, such as falls and cognitive decline.

Despite global trends in promoting restraint-free environments in aged care, restrictive practices are common in Australia, the royal commission found.

“In many instances, restraints are used as a first-line response to manage behaviours that are challenging for staff and others in residential aged care, contrary to available guidance and evidence,” the royal commission said.

“The indiscriminate use of restrictive practices on older people in Australia is unacceptable.”

Despite the high levels of prescription, there was “very limited monitoring” of whether GPs were complying with restrictions imposed under the Pharmaceutical Benefits Scheme on psychotropic medicines such as Risperidone, widely used to control so-called challenging behaviours by residents with dementia.

The commission heard evidence the compliance carried out by the Health Department was intended to “protect the integrity of Australia’s health payment system” rather than ensuring medically appropriate prescription.

“Given what we have learned about the frequent prescription of these types of medications by general practitioners, it may be appropriate to limit their initiation in residential aged care facilities to registered psychiatrists.”