Public subsidies for antipsychotic medications used in nursing homes should be restricted to curb the “outrage” of harmful overprescribing of the powerful drugs to elderly Australians, experts say.
Three of Australia’s top figures in healthcare provision for the elderly made the call as a high-level stakeholder meeting in Sydney yesterday considered how to combat high rates of inappropriate drug prescribing for the elderly.
Previously unreported findings of a key federal drugs-use committee has, meanwhile, backed concerns about antipsychotic overprescribing among Australians, confirming “high and inappropriate utilisation” in the elderly and declaring overall use “a major quality use of medicines problem”.
A former chairman of the drug utilisation subcommittee, David Le Couteur, told The Australian that high rates of prescribing of antipsychotics to the elderly with dementia in residential aged-care were “an outrage”.
This prescribing was “in nearly all cases inappropriate, harmful (and) generating reduced quality of life and increased mortality” and was done because it made it “just easier” to manage residents.
A quarter of those in aged-care facilities, equating to an estimated 50,000 people, were on antipsychotics, “mostly to try to control their behaviour”.
Professor Le Couteur said the withdrawal of Pharmaceutical Benefits Scheme subsidies for antipsychotics prescribed to those with dementia in residential aged-care after three months — unless a specialist continued them — would provide a “reason to stop”.
The comments follow a report in The Weekend Australian revealing that doctors are putting an average of 20,000 additional Australians a year on antipsychotics, many of which are being prescribed “inappropriately” for common conditions such as sleep and anxiety problems.
The report quotes experts noting that while antipsychotics are an important and lifesaving treatment for serious conditions, they could have serious side-effects.
Antipsychotics can cause weight gain and metabolic disturbances, and studies have linked antipsychotic use in older people with dementia to increased mortality, with experts also linking them to falls and strokes among the elderly.
The Australian can reveal that a previously unreported February 2013 outcome statement from a meeting of the drug utilisation subcommittee found a committee “analysis” of drug data had “demonstrated … high and inappropriate utilisation of antipsychotics in the elderly”.
“DUSC considered that the increasing use of antipsychotics, without a proportionate increase in the prevalence of the PBS-listed indications, is a major quality use of medicines problem,” it said.
Sydney University older people healthcare professor Susan Kurrle said PBS limitation would control “shotgun therapy”; Sydney Medical School professor of geriatric pharmacology Sarah Hilmer said it was a “sound, evidence-based idea”.
Melbourne University professor of youth mental health Pat McGorry has defended the use and importance of antipsychotics, saying “for patients who respond well to antipsychotics, the benefits definitely outweigh the problems”.
Experts warn that stopping antipsychotics can cause negative and dangerous outcomes and advise those with concerns to see a doctor.
This article first appeared on ‘The Australian’ on 4 August 2015.