Objective: To determine the pattern of use of psychotropic drugs in Sy
dney nursing homes. Design: Survey of data from medical records of res
idents and interviews with residents and staff. Setting: Central Sydne
y Health Area, June to December 1993. Participants: All residents of 4
6 of the 47 nursing homes in the western sector of the health area. Ma
in outcome measures: Psychotropic drugs used regularly or as required.
Degree of cognitive impairment and depression rated on interview with
residents, using Mini-Mental State Examination and Geriatric Depressi
on Scale. Behavioural disturbances reported by staff. Results: Most re
sidents (58.9%) were taking one or more psychotropic drugs regularly a
nd another 7% were prescribed these drugs as required. Neuroleptic wer
e taken regularly by 27.4% and as required by a further 1.4% (at lease
one dose in the previous four weeks), but doses were equivalent to mo
re than 100 mg/day of chlorpromazine for only 8.8%. Neuroleptics were
more likely to be given to residence with greater cognitive impairment
and more disturbed behaviour. Other psychotropic drugs in regular use
were: benzodiazepines (32.3%); hypnotics (26.6%); antidepressant (15.
6%); and anxiolytics (8.6%). At least half of antidepressant doses wer
e subtherapeutic. Of 874 residents who responded to a depression quest
ionnaire, 30% scored as significantly depressed; one-third of these of
these were taking antidepressants. Conclusions: The percentage of res
idents in Central Sydney nursing homes who were taking neuroleptics, h
ypnotics or anxiolytics is among the highest reported from geriatric i
nstitutions around the world. Prescribing practices in Australian nurs
ing homes need to be reviewed.