PSYCHOTROPIC-DRUG USE IN SYDNEY NURSING-HOMES

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.