Elderly in care 20 times more likely to be on antipsychotics

Sharp rise in medication, including chemical calming ‘cosh’, revealed in database study by Queen’s University Belfast

Prescriptions for psychotropic drugs, including those sometimes referred to as the “chemical cosh”, soar amongst elderly people who are admitted to residential care homes, a new study shows.

The study, in the Journal of the American Geriatrics Society, looks at the prescribing of drugs to calm anxiety and sedate, as well as the antipsychotics which are supposed to be prescribed for severe mental health conditions such as schizophrenia and bipolar disorder and only for dementia as a last resort.

The researchers, from Queen’s University Belfast, carried out the study using information from the Northern Ireland prescribing database relating to over 250,000 people over the age of 65, but, they say, the pattern they found holds good for the whole of the UK.

They discovered that only 1.1% of elderly people living in the community in their own homes or with relatives were taking an antipsychotic – the so-called “chemical cosh” drugs, which the Medicines and Healthcare Products Regulatory Agency (MHRA) warns are not appropriate for most people with dementia.

But in care homes, 20.3% of residents were on them. They also looked at the dispensing records for those elderly people who made the move into care between January 2009 and January 2010 into care. Their medication shot up. In their own homes, 1.1% were on antipsychotics, 7.3% were on hypnotics – sedatives or mood stabilisers – and 3.6% were on drugs for anxiety.

Once in a care home, 8.2% were put on antipsychotics, 14.8% were given hypnotics and 7.8% were prescribed anxiolytic. One year later, the amount of drugs they were on had jumped again and 18.6% were on antipsychotics.

Within six months of admission to a care home, say the authors, 30.2% of all new residents had received at least one prescription for an antipsychotic, 37.1% for a hypnotic and 24.5% for an anxiolytic.

Lead researcher Aideen Maguire, who is based in the Centre of Excellence for Public Health Northern Ireland said: “Although drug dispensing is high in older people in the community, we have found that it increases dramatically on entry to care. This study showed that the high uptake of psychotropic drugs observed in care homes in Northern Ireland cannot be explained by a continuation of drug use initiated in the community prior to entering care.

“With an ageing population globally it is important that we look at the reasons behind this type of increase following admission to care. Antipsychotic uptake in Northern Ireland is similar to that in the rest of the UK and Ireland, and this study highlights the need for routine medicines reviews especially during the transition into care.”

Their study could not ascertain how appropriate the prescribing was, she said, and it was possible that those people who moved into care either did so because of mental health problems or became anxious over the move. But, she said, “there is probably inappropriate prescribing going on.” Other studies have also shown high levels of antipsychotic drug prescribing for elderly people in care homes in Britain.