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New guidance for antipsychotic use in elderly

New guidance to help with antipsychotic use in elderly

PHARMAC and the College of Psychiatrists have today jointly launched new guidance on the use of antipsychotic medicines in the elderly.

The guidance is aimed at doctors treating elderly patients with powerful antipsychotic medicines, and follows concern internationally about high use of antipsychotics in elderly patients.

Concern has been expressed both in the United States and the UK about high rates of use of antipsychotics in elderly people. This includes potential health risks (possible increased risk of stroke and higher death rates), and concern from the UK All-Party Parliamentary Group on Dementia that over-prescription of antipsychotics to people with dementia in care homes does significant harm.

It’s unclear whether there is significant over-prescribing of antipsychotics in New Zealand, though PHARMAC’s prescribing data shows that there is comparatively high use of antipsychotics among older people. For example, in 2006/07 about 20% of older-generation antipsychotics, 24% of risperidone and 17% of quetiapine prescriptions were for people aged between 80 and 90 years. And about 35,000 prescriptions were recorded for people aged 80-90.

“When this data is coupled with growing international concern about the use of antipsychotics in the elderly, we think it’s the right time to develop guidance on how best to use these medicines,” says PHARMAC’s medical director Dr Peter Moodie.

“This isn’t about telling doctors how to do their jobs, it’s about ensuring these medicines are used well and risks to patients are minimised,” says Dr Moodie. “We have worked with the College of Psychiatrists to develop this review mechanism, and we hope it will be used to ensure that when a decision is made to prescribe these medicines for elderly patients, that decision is made using up-to-date guidance.”

The guidance encourages evidence-based treatment of elderly people in residential care with psychological and behavioural symptoms of mental disorders. Dementia is the most common psychiatric disorder in this group of people.

Dr Matthew Croucher, New Zealand spokesperson for the Royal College of Psychiatrists on this matter, adds: “Older people in residential care should expect the very best standards of health care. The College of Psychiatrists has fully supported this PHARMAC initiative.

“Although there is little evidence of systematic harms being caused in New Zealand, there is plenty of room for improved prescribing and review of antipsychotic medicines and for improved overall management of challenging mental health problems in residential care.”

PHARMAC has worked with the Best Practice Advocacy Centre (BPAC NZ) to develop review tools which can be used by residential care facilities to ensure that the use of antipsychotics is appropriate. This programme is supported by a ‘Best Practice’ guide to the treatment of behavioural and psychological symptoms of dementia.

Dr Moodie says that the intention is for staff at residential care facilities to work closely with other health professionals such as General Practitioners and community pharmacists to conduct these patient reviews and improve the quality of prescribing.


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