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Rethinking psychotropics in nursing homes

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To the Editor: We thank Hilmer and Gnjidic for highlighting the excessive use of psychotropic medications in Australian nursing homes.1 We recently completed a national psychotropic audit of over 9000 nursing home medication reviews conducted during the 2011–12 financial year. Our results were alarming: even after excluding residents with schizophrenia or bipolar disorder, more than a quarter of residents reviewed (27%) were taking antipsychotics. Concerningly, 41% of all residents reviewed were prescribed benzodiazepines.

Such findings are not new. The problem of excessive psychotropic use in Australian nursing homes has been reported for nearly 20 years and has been the subject of both federal and state inquiries.

As possible solutions, Hilmer and Gnjidic suggest economic evaluations and investment in staff and in research to develop better management strategies.1 Yet, qualitative research has determined that a major reason for high prescribing lies in an overestimation of the efficacy of psychotropic medications and limited awareness of their adverse effects.2 Consequently, awareness-raising and education of health practitioners and residents’…