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Cited by 29Pharmaceutical Practices and Patient OutcomesGeriatric Care and Nursing HomesDementia and Cognitive Impairment Research

The burden of psychotropic and anticholinergic medicines use in care homes: population-based analysis in 147 care homes

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Grill, Paula, Marwick, Charis, De Souza, Nicosha, Burton, Jennifer Kirsty, Hughes, Carmel, Guthrie, Bruce·2021·Age and Ageing
DOI 10.1093/ageing/afaa122
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Abstract

BACKGROUND: older people living in care-homes are particularly vulnerable to adverse effects of psychotropic and anticholinergic drugs. METHODS: anonymised dispensed prescription data from all 4,478 residents aged ≥ 60 years in 147 care-homes in two Scottish health boards were analysed. Psychotropic medicines examined were antipsychotics, antidepressants, hypnotic/anxiolytics, opioids and gabapentinoids. Anticholinergic burden was measured using the modified anticholinergic risk scale (mARS). Variation between care-homes and associations with individual and care-home characteristics were examined using multilevel logistic regression. RESULTS: 63.5% of residents were prescribed at least one psychotropic drug, and 27.0% two or more, most commonly antidepressants (41.6%), opioids (20.3%), hypnotic/anxiolytics (16.9%) and antipsychotics (16.7%). 48.1% were prescribed an anticholinergic drug, and 12.1% had high anticholinergic burden (mARS ≥ 3). Variation between care-homes was high for antipsychotics (intra-cluster correlation coefficient [ICC] 8.2%) and hypnotics/anxiolytics (ICC = 7.3%), and moderate for antidepressants (ICC = 4.7%) and anticholinergics (ICC = 2.8%). Prescribing of all drugs was lower in the oldest old. People with dementia were more likely to be prescribed antipsychotics (adjusted OR = 1.45, 95%CI 1.23-1.71) but less likely to be prescribed anticholinergics (aOR = 0.61, 95%CI 0.51-0.74). Prescribing of antipsychotics was higher in Tayside (aOR = 1.52, 95%CI 1.20-1.92), whereas prescribing of antidepressants (particularly tricyclic-related) was lower (aOR = 0.66, 95%CI 0.56-0.79). There was no association with care-home regulator quality scores. CONCLUSION: care-home residents have high psychotropic and anticholinergic burden, with considerable variation between care-homes that is not related to existing measures of quality of care. Research to better understand variation between care-homes and the interaction with local prescribing cultures is needed.

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  • The findings of this review help explain the findings of previous studies that have shown high rates of inappropriate psychotropic prescribing in older people both in care homes and wider settings.

    “The findings of this review help explain the findings of previous studies that have shown high rates of inappropriate psychotropic prescribing in older people both in care homes [4–7] and wider settings [83].”

    From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [6]

    The Discussion reports high psychotropic prescribing among older care-home residents. But it explicitly says the study cannot determine whether prescribing was appropriate, so it does not establish high rates of inappropriate prescribing. The sentence cites a different source for wider settings. (LLM, conf=0.90)

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  • Rates of psychotropic prescribing are particularly high across care homes in Western Europe, where up to 63% of residents are prescribed at least one psychotropic drug.

    “Rates of prescribing are particularly high across care homes, where studies in the Western Europe have shown that up to 63% of residents are prescribed at least one psychotropic drug [5–8].”

    From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [6]

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Authors
Grill, P., Marwick, C., De Souza, N., Burton, J. K., Hughes, C., & Guthrie, B.
Affiliations
  • University of Dundee (GB)
  • Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
  • University of Glasgow (GB)
  • Queen's University Belfast (GB)
  • University of Edinburgh (GB)
Corresponding author
Guthrie, Bruce
ORCID
Venue
Age and Ageing
Publisher
Oxford University Press (OUP)
Published
2020-07-22
Volume
50
Issue
1
Pages
183-189
ISSN
  • 0002-0729 (ISSN-L)
  • 1468-2834
DOI
10.1093/ageing/afaa122
OpenAlex
W3044764123
Cited by
29
References
26
Citations by year
2026: 1 · 2025: 6 · 2024: 10 · 2022: 6 · 2021: 5 · 2020: 1
FWCI
1.57
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • Age and Ageing (publishedVersion)
  • PubMed (publishedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, other-oa)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • Research Portal (Queen's University Belfast) (submittedVersion, other-oa)
  • Discovery Research Portal (University of Dundee) (submittedVersion, other-oa)
Funders
Medical Research Scotland (1198–2018)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
psychotropic drugs, anticholinergic burden, care homes, older adults, antipsychotic drugs, antidepressants, opioids, gabapentinoids, dementia, prescribing variation, quality of care, tricyclic antidepressants, oldest old, Scotland, Tayside, adverse drug reactions
MeSH terms
Aged, Aged, 80 and over, Antidepressive Agents, Cross-Sectional Studies, Humans, Nursing Homes, Psychotropic Drugs, Cholinergic Antagonists

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