Nursing home medication reviews insufficient

Nursing home residents may not be receiving regular and sufficient reviews of psychotropic medications, a study shows. A small six-month audit of 166 newly-admitted residents across seven nursing homes in Melbourne has shown that antidepressants and antipsychotics had similar rates of prescription, around 5-6%, but antidepressants were rarely ceased while stop rates of antipsychotics were slightly more dynamic. The results are concerning because previous studies have shown under-treatment and recognition of depression in nursing homes and that antipsychotics are often unnecessary and can be withdrawn without ill effects, say the authors. “Residents who remained depressed, despite taking an antidepressant, might therefore have been deprived of treatment opportunities. While antipsychotics were stopped more often, most prescriptions remained unchanged over the six-month period,” write the authors in International Psychogeriatrics. Benzodiazepine use was modest and stopped frequently, “pointing to notable improvements in practice over time”, they say. “Treatment revisions were almost certainly insufficient to address residents’ mental health needs,” the researchers write, but the audit was small and might not be representative of nursing home practice throughout Australia. They suggest appointing mental health nursing specialists to “champion” the screening of new residents and regular follow-ups with primary care physicians, promote care pathways, refer to aged psychiatry services and staff education....