Aged care: why medication reviews are not popular in nursing homes

Article published 16 December 2020

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THE smart thing for a nursing home to do when a new resident comes in is to arrange for a review of their medication. On average, nursing home residents are taking ten different medications every day, plus short-term medicines like antibiotics. Taking lots of medications, but also age-related changes, can make older frail people susceptible to problems with medications. A medication review is important.

A Residential Medication Management Review is a free service for which every permanent nursing home resident is eligible. It is conducted by a pharmacist. The review is comprehensive and aims to identify, resolve and prevent medication-related problems.

However, only one-in-five aged care residents receives a medication review within ninety days of entering an aged care facility, a new study shows, even though it’s free to the resident and to the nursing home.

The research from the Registry of Senior Australians at the South Australian Health and Medical Research Institute analysed the data of 143,676 residents across all 2,799 nursing homes nationally between 2012 and 2015.

Not all nursing homes performed the same. For example, there were 300 nursing homes which never had any medication reviews done, while only four did reviews as recommended, 100 per cent of the time. Six per cent of nursing homes carried out medication reviews on more than half of all new residents.

Yet, the Residential Medication Management Review has been around for more than twenty years.

The researchers want awareness about the Residential Medication Management Review to be raised. This is certainly a good idea, particularly awareness among family members and residents themselves, so that they can ask for a medication review.

However, the research spanned 2012 to 2015 and looked at nursing homes before the Aged Care Royal Commission did. The Royal Commission found that psychotropic medications were massively over-prescribed in nursing homes. Psychotropic medications should be prescribed for anxiety, depression, psychosis and mood disorders. However, nursing homes were found to use these medications to drug people with dementia and behavioural issues related with their condition.

Geriatrician Edward Strivens said the drugs were useful in about ten per cent of cases, but that up to eighty per cent of dementia patients are taking some form of psychotropic medication.

“The side effects will often outweigh the possible benefits,” Strivens told an aged care royal commission hearing.

CPSA wonders if the low utilisation rate of Residential Medication Management Reviews may have been caused by nursing homes not wanting to have exposed that they routinely over-prescribe psychotropic medications.

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