Psychotropic Medications and Quality of Life in Residential Aged Care Facilities

Recent clinical recommendations state that many psychotropic medications should be avoided wherever possible in people with cognitive impairment and dementia. Psychotropic medications have been associated with increased risk of falls, hospitalization, stroke and mortality in residents of aged care facilities. The objective of this study was to examine associations between psychotropic medications and quality of life in older adults living in residential care facilities. The population was from a cross-sectional study of 537 residents from 17 different residential aged care facilities in Australia, with a high prevalence of cognitive impairment and dementia. Overall, 70.8% (n=380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. Participants residing in facilities which had adopted a person-centred, ‘cottage model’ of residential care had a lower prevalence of psychotropic medications (OR (95% CI): 0.26 (0.14, 0.52), p<0.001). An increased number of psychotropic medications were associated with poorer quality of life according to DEMQOLProxy-Utility scores (β (SE): -0.012 (0.006), p=0.03) and EQ-5D-5L scores (-0.026 (0.011), p=0.02) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with poorer DEMQOLProxy-Utility scores (-0.030 (0.013), p=0.03) and benzodiazepines were associated with poorer EQ-5D-5L scores (-0.062 (0.024), p=0.01). In conclusion, an increased number of psychotropic medications were associated with poorer quality of life. These medications have many adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care.