Neuroleptic prescribing to the community elderly in Nottingham

A cross-sectional pilot survey of computerized prescribing databases and written general practitioner records. Data were abstracted by the first author using a standard proforma.

Six out of 12 general practices situated in an area of north Nottingham known to have a high density of residential and nursing homes cooperated with the exercise (one was excluded because it lacked a computer system, one because the principal had a specialist commitment to old age psychiatry and four were self-excluded).

Patients recorded as receiving repeat prescriptions of oral preparations of thioridazine, chlorpromazine, promazine, haloperidol or trifluoperazine.

Point prevalence rates of neuroleptic repeat prescribing classed by age group and, in the case of the elderly, residential status. For elderly recipients: median (range) duration on neuroleptics, median (range) time since last review and numbers (percentages) having various characteristics.

Elderly patients were found to be more likely consumers of neuroleptic medication than their younger counterparts. If these results are extrapolated nationwide, then approximately half the patients receiving repeat prescriptions for the commonest oral neuroleptics emerge as elderly and of these about half are in nursing/residential care. Patients in nursing/residential homes suffering dementia formed the largest group of recipients, but have the least monitoring by psychiatric teams.

The result highlight a need for a close partnership between primary care, community care facilities and old age psychiatric teams to ensure adequate monitoring and the implementation of psychological strategies to minimize their use.