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Rethinking psychotropics in nursing homes

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To the Editor: The article by Hilmer and Gnjidic1 raises issues about the management of behavioural and psychological symptoms of dementia (BPSD)2 in residential aged care facilities (RACFs).

It is important to remember the context in which RACF residents’ care is provided. The federally managed aged care system is politically and organisationally perceived as supported accommodation, which is geared toward supporting or substituting for residents’ performance of basic and instrumental activities of daily living. This system is outside the state-based health care system. Health care, effectively an optional extra in this context, is provided by general practitioners, who may have no prior knowledge of the resident before admission.

RACF residents in high-level care are too sick and disabled, many suffering from moderate or severe dementia and in the palliative phase of their illness, to be supported by the state health system in the community. BPSD are an everyday fact of life that cause distress to those suffering them and their fellow residents and can make it impossible for carers to provide essential care safely.

Yes, BPSD can be managed by non-pharmacological…