Antipsychotic and sedative medication use in long-term care facilities providing dementia care

This study aimed to quantify use of antipsychotic and sedative medications in residents with dementia in long-term care facilities in the Waikato District Health Board (DHB) catchment and to identify factors associated with the prescription of these medications.

Resident records and the medication charts of 271 residents with a diagnosis of dementia from 13 dementia units in the Waikato DHB catchment, as well as the psychogeriatric (PG) unit, were reviewed for current prescriptions for any antipsychotic or sedative medication and the date those medications were most recently prescribed.

Antipsychotics were prescribed for 133 (49.1%) residents, with a mean (95% CI) of 401 (354-448) days since the most recent prescription was made. Only 16.8% of antipsychotic prescriptions were prescribed in the preceding 12 weeks, with 31.3% of prescriptions prescribed more than a year prior. Residents were more likely to be prescribed an antipsychotic if they were male (56.9% vs 42.6%, p=.019) or had an incident form completed (30.8% vs 19.6% p=.03). Regression analysis showed only gender (OR 1.79, 95%CI 1.07-2.98, p=.026) was associated with antipsychotic medication prescription. Sedatives were prescribed for 60 (22.1%) residents, with a mean (95%CI) of 487 (431-544) days since the most recent prescription was made, and 44.8% of prescriptions were dated more than a year prior. Residents were more likely to be prescribed a sedative if they entered the facility at a younger age (76.9 vs 79.5, p=.042) or had been in the current facility longer (980 vs 734 days, p=.048). Following regression analysis, no individual factors were significantly associated with sedative prescription.

With clear evidence of the risks of antipsychotics to patients with dementia, the proportion of residents prescribed an antipsychotic or sedative in this study, in conjunction with the prolonged duration of prescription, is cause for concern and needs addressing.