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Prescribed change
Increase in psychotropic meds linked to GP changes .
By Eleanor Campbell
People with dementia entering aged care experience higher increases in medication when changing GPs , a recent study has found .
UNSW researchers analysed data from 2,250 people with dementia who had entered residential care from the Sax Institute ’ s 45 and Up study in NSW .
Almost half of residents who changed to a new GP were associated with an increase in initiation of medicine , including antipsychotics and benzodiazepines .
High rates of hyper polypharmacy , the prescribing of ten or more medications , was also linked to changes in primary health carers .
“ We knew that polypharmacy is an issue with older people , and particularly in aged care settings ,” said lead author Dr Heidi Welberry .
“ It ’ s not that being on multiple medications is necessarily a bad thing , but the more medication somebody is on , the higher the risk of interactions or medication mistakes .”
While appropriate in some cases , the prescribing of multiple medications in aged care facilities has been linked to higher rates of hospitalisation among the elderly .
The study did not investigate why a change in GP had led to an increase in medication . According to Dr Welberry , a lack of knowledge and understanding towards a resident ’ s prior medical history is a potential factor .
“ I guess it ’ s a really difficult situation when somebody enters residential care ,” she said .
“ They have a much briefer period of time to have built a relationship with the patient at that entry point , so they don ’ t have that long history with them .”
UNDERLYING TRAUMA Concerns over the dispensing of psychotropic medications to aged care residents came to a head during the royal commission , which called for stricter requirements to reduce prescriptions .
Adverse risks associated with such medicines in people with dementia include increased sedation , strokes , falls , Parkinson ’ s disease-like symptoms , and higher rates of mortality .
A recent report found that of the 100,000 aged care residents thought to be living with dementia in Australia , up to 48 per cent are receiving antipsychotics .
Co-director of the UNSW Centre for Healthy Brain Ageing , professor Henry Brodaty , said the use of drugs like risperidone to treat dementia-related behaviours should remain a last resort option .
“ It ’ s easier to prescribe than to institute a regimen of person-centred care .
“ In general , always try non-pharm strategies first ; work with families , rule out dementia cause …[..] always obtain consent before giving meds , monitor for effects ,” he said .
For residents with a prior diagnosis of dementia , this transition may exacerbate behavioural changes and trigger an increase or initiation in psychotropic medications .
“ For anyone going into a nursing home it is a wrench from their usual life ,” said Brodaty .
“ Imagine you did not make that decision yourself , or that you forgot you agreed
“ It ’ s easier to
prescribe than to institute a regimen of person-centred care .
to being admitted or you have just been transferred from hospital to a nursing home – it would be traumatic .”
GPs AND TRANSITIONS INTO AGED CARE Ensuring that GPs are supported during the transition process is crucial to avoiding potential medication errors , according to Royal Australasian College of Practitioners ( RACP ) spokesperson Dr Mark Morgan .
“ The research reflects that continuity of care is really important ,” he said .
“ When I see someone in a residential care facility often all I have to go on is what a person can tell me , and diagnoses that might or might not be correct , and a list of pills .”
More streamlined access and unified transfers to health records , promoting more medication reviews and improving financial support to facilitate more time during evaluations , are potential solutions to better assist general practitioners .
“ It is medically complex work , it is relatively underpaid , and
GPs often need to take a significant amount of time away from their clinic to see people in residential facilities ,” said Dr Morgan .
Shortages in registered nurses and workers in aged care facilities is another core factor influencing prescription decisions , said
Dr Morgan . “ The nursing staff are so few and far between , particularly out of hours , that it is difficult to prescribe medicines that are to be taken only if needed under certain circumstances .
“ Your way of prescribing has to change according to the staffing levels of a nursing home that you have no personal control over at all .”
In early July , GPs were offered double pay as part of government efforts to incentivise them towards the aged care workforce . Around 40 million dollars was allocated towards improving primary care access for elderly and immobile patients .
Investments have been welcomed , however there have been concerns that the incentives do not recognise the complexities of the work .
“ It doesn ’ t really encourage continuity of care with a GP that knows you ,” said Dr Morgan . ■
2 agedcareinsite . com . au