(ASPOT22) Psychotropic medication use in Australian aged care before and after aged care reforms, 2018 and 2022

Background: The overuse of psychotropic medication in residential aged care (RAC) is a concern globally. Since 2019, Australia has been implementing a range of aged care reforms, some of which aim to reduce the use of psychotropic medications. The reforms have included mandatory quarterly reporting on the prevalence of antipsychotic use and written consent to use physical or chemical restraint, both implemented in 2021. To date, it is unknown if psychotropic medication use has changed since these reforms, including if there are any unintended consequences such as switching between classes of psychotropics.

Objectives: To compare the prevalence of psychotropic medication use (antipsychotics, antidepressants, antiepileptics, medications for sleep disorders/anxiolytics) in RAC in 2018 with 2022.

Methods: We conducted a repeated cross-sectional analysis of psychotropic medication use by residents in RAC facilities which all used the same electronic medication system. Medication administration data were extracted. Residents were eligible for inclusion if they were administered one or more medications and had a cumulative stay >100 days. The annual prevalence of use of four psychotropic medication classes was calculated and a two-sample test of proportions was applied to estimate the difference in proportions between 2018 and 2022 with their 95% confidence interval (CIs).

Results: In total, there were 428 RAC facilities with 52,201 residents. The prevalence of antipsychotic use decreased significantly from 28.8% in 2018 to 20.2% in 2022 (-8.61%; 95% CI: -7.59% to -9.60%). Similar reductions were also seen in the use of medications for sleep disorders/anxiolytics from 34.3% to 26.8% (-7.5%; 95% CI: -8.60 to -6.40) and anticonvulsants from 24.8% to 20.3% (-4.50; 95% CI: -5.50% to -3.50%). However, there was a small increase in antidepressant use from 46.7% to 48.2% (1.5%; 95% CI: 0.39% to 2.70%). Overall, the use of the four classes of psychotropics decreased from 74.3% to 69.1% (-5.20%; 95% CI: -6.30% to -4.20%).

Conclusions: When comparing psychotropic medication use before and after major aged care reforms, there were reductions in use of antipsychotics, anticonvulsants and medications for sleep/anxiolytics. While there were also changes in the use of antidepressants, these are unlikely to be clinically meaningful. Ongoing monitoring of program outcomes is important to ensure there are no unintended consequences, such as switching to classes of psychotropics other than antipsychotics.