Dementia and use of psychotropic medication in non-'Elderly Mentally Infirm' nursing homes in South East England

Abstract

Background: There is concern about inappropriate use of psychotropic medication in nursing homes in the UK. Older people with advanced dementia, who might need such medication, are supposed to be admitted to specialist 'Elderly Mentally Infirm' homes. Objectives: To estimate the prevalence of dementia and psychotropic medication use in UK non-Elderly Mentally Infirm homes. Design: a) Probability sample of non-elderly mentally infirm places in nursing-homes in South-East England then b) two-stage survey of a probability sample of residents in these places. Setting: Non-Elderly Mentally Infirm nursing homes for older people in SE England. Subjects: Residents registered non-Elderly Mentally Infirm homes. Methods: Assessment using mini mental state examination for cognitive impairment, the Behave-AD for behavioural problems and the Cornell Scale for depression. Mini mental state examination scores were validated against independent psychiatric assessment in a sub-sample of residents. We gathered medication data from prescription sheets. Results: Of the 445 residents 74% assessed had probable clinical dementia. Of all the residents 38% had severe cognitive impairment, with a three-fold higher rate of behavioural disturbance than others. Psychotropic medication was strongly associated with cognitive impairment. Antipsychotic drugs were prescribed for only 15% of all residents. Conclusions: If nearly three-quarters of non-Elderly Mentally Infirm nursing home residents have dementia, many with behavioural disturbance, then dementia care is not a 'specialist' area of nursing home care. This study offers no support for the hypothesis that use of antipsychotic drugs in nursing homes is excessive. Questions are raised about policy, staffing and training in nursing homes.