National Aged Care Reforms and Trends in Psychotropic Medication Use in 428 Residential Age Care Facilities,...

To assess changes in the prevalence of psychotropic medication administration in Australian residential aged care (RAC) during a period of national reforms, including the introduction of mandatory reporting of antipsychotic use.

A retrospective cohort study using routinely collected electronic medication administration data.

Daily medication administration data for 52,201 residents of 428 RAC facilities in 7 Australian states and territories between January 2018 and December 2022.

We estimated the percentage of residents administered psychotropic medications from 4 classes (antipsychotics, sedatives and anxiolytics, antiseizure medication, antidepressants) at least once in each calendar month. The relative monthly average percentage change (RAPC) in prevalence by dementia status was the primary outcome.

Significant reductions occurred in the administration of antipsychotic, sedative and anxiolytic, and antiseizure medication to residents with and without dementia between 2018 and 2022. However, administration of antidepressants increased in residents with dementia over the same period. Residents with dementia experienced an RAPC of -34.6% (95% CI: -41.1, -28.2; P < .001) for antipsychotics, -38.5% (95% CI: -48.3, -28.7; P < .001) for sedatives and anxiolytics, -28.6% (95% CI: -38.1, -19.1; P < .001) for antiseizure medication, and 11.9% (95% CI: 5.44, 18.4; P < .001) for antidepressants. Residents without dementia experienced an RAPC of -31.7% (95% CI: -40.2, -23.1; P < .001) for antipsychotics, -35.3% (95% CI: -42.8, -27.9; P < .001) for sedatives and anxiolytics, -12.5% (95% CI: -20.2, -4.82; P < .001) for antiseizure medication, and no change for antidepressants.

Between 2018 and 2022, use of 3 psychotropic medication classes declined in Australian RAC. However, antidepressant use increased in people with dementia, potentially as a form of chemical restraint. Ongoing monitoring of the national Quality Indicator program and other initiatives is crucial to ensure there are no unintended consequences such as switching between psychotropic medication classes.