Trends in Falls and Medicine Use in Australian Long-Term Care, 2014-2022: Evidence From 8298 Residents

To evaluate changes in falls and medication-related quality indicators (QIs) including high sedative load, antipsychotic use and anti-anxiety or hypnotic medications in long-term care facilities (LTCFs), and to examine their alignment with major national reforms and COVID-19 in New South Wales, Australia.

A repeated cross-sectional study was conducted using electronic health data from 27 LTCFs (8298 residents). From Jul 2014 to Jun 2022, quarterly prevalence estimates of four QIs were evaluated adjusting for potential confounders. Joinpoint regression analysis was used to identify QI trend changes. Average quarterly percentage changes for the study period were estimated.

The quarterly prevalence of residents who had any falls (28.5%-33.3%) and injurious falls (14.5%-18.6%) remained stable during the study period. The prevalence of residents who had falls requiring hospitalisation varied (3.8%-9.1%) and average quarterly percentage increase was 1.01% (95% confidence interval (CI) 0.30, 2.08). There were changes in quarterly prevalence of residents experiencing high sedative load (28.1%-32.1%), using antipsychotic(s) (8.9%-19.3%), and anti-anxiety and hypnotic medication(s) (11.4%-19.0%). Average quarterly percentage decreases were at 0.17% (95% CI 0.01, 0.35) in residents experiencing a high sedative load, 2.14% (95% CI 1.90, 2.41) for antipsychotics use and 1.63% (95% CI 1.45, 1.82) for anti-anxiety or hypnotic medication use. Regarding trend changes, medication-related QIs decreased from Q3 or Q4 2018, or Q1 2019, around when the Royal Commission was established. Medication-related QIs continued to decline when restrictions on risperidone were applied and COVID-19 started.

Medication-related QIs decreased during the study period, especially after national reforms.