National aged care reforms and trends in psychotropic medication use in 428 residential age care facilities, 2018-2022

Magdalena Z. Raban; Bayzidur Rahman; Nasir Wabe; Ling Li; Elizabeth Manias; Mark Morgan; Tracey Bucknall; Ian D. Cameron; J. Simon Bell; Sandun S. Silva; Rajendra Gyawali; Johanna I. Westbrook

doi:10.1016/j.jamda.2025.105832

National aged care reforms and trends in psychotropic medication use in 428 residential age care facilities, 2018-2022

Magdalena Z. Raban, Bayzidur Rahman, Nasir Wabe, Ling Li, Elizabeth Manias, Mark Morgan, Tracey Bucknall, Ian D. Cameron, J. Simon Bell, Sandun S. Silva, Rajendra Gyawali, Johanna I. Westbrook

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: To assess changes in the prevalence of psychotropic medication administration in Australian residential aged care (RAC) during a period of national reforms, including the introduction of mandatory reporting of antipsychotic use.

Design: A retrospective cohort study using routinely collected electronic medication administration data.

Setting and Participants: Daily medication administration data for 52,201 residents of 428 RAC facilities in 7 Australian states and territories between January 2018 and December 2022.

Methods: We estimated the percentage of residents administered psychotropic medications from 4 classes (antipsychotics, sedatives and anxiolytics, antiseizure medication, antidepressants) at least once in each calendar month. The relative monthly average percentage change (RAPC) in prevalence by dementia status was the primary outcome.

Results: Significant reductions occurred in the administration of antipsychotic, sedative and anxiolytic, and antiseizure medication to residents with and without dementia between 2018 and 2022. However, administration of antidepressants increased in residents with dementia over the same period. Residents with dementia experienced an RAPC of -34.6% (95% CI: -41.1, -28.2; P < .001) for antipsychotics, -38.5% (95% CI: -48.3, -28.7; P < .001) for sedatives and anxiolytics, -28.6% (95% CI: -38.1, -19.1; P < .001) for antiseizure medication, and 11.9% (95% CI: 5.44, 18.4; P < .001) for antidepressants. Residents without dementia experienced an RAPC of -31.7% (95% CI: -40.2, -23.1; P < .001) for antipsychotics, -35.3% (95% CI: -42.8, -27.9; P < .001) for sedatives and anxiolytics, -12.5% (95% CI: -20.2, -4.82; P < .001) for antiseizure medication, and no change for antidepressants.

Conclusions and Implications: Between 2018 and 2022, use of 3 psychotropic medication classes declined in Australian RAC. However, antidepressant use increased in people with dementia, potentially as a form of chemical restraint. Ongoing monitoring of the national Quality Indicator program and other initiatives is crucial to ensure there are no unintended consequences such as switching between psychotropic medication classes.

Original language	English
Article number	105832
Pages (from-to)	1-7
Number of pages	7
Journal	Journal of the American Medical Directors Association
Volume	26
Issue number	11
Early online date	12 Sept 2025
DOIs	https://doi.org/10.1016/j.jamda.2025.105832
Publication status	Published - Nov 2025

Bibliographical note

Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Health care reform
health policy
medication therapy management
nursing homes
psychotropic drugs

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10.1016/j.jamda.2025.105832Licence: CC BY

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Raban, M. Z., Rahman, B., Wabe, N., Li, L., Manias, E., Morgan, M., Bucknall, T., Cameron, I. D., Bell, J. S., Silva, S. S., Gyawali, R., & Westbrook, J. I. (2025). National aged care reforms and trends in psychotropic medication use in 428 residential age care facilities, 2018-2022. Journal of the American Medical Directors Association, 26(11), 1-7. Article 105832. https://doi.org/10.1016/j.jamda.2025.105832

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title = "National aged care reforms and trends in psychotropic medication use in 428 residential age care facilities, 2018-2022",

abstract = "Objectives: To assess changes in the prevalence of psychotropic medication administration in Australian residential aged care (RAC) during a period of national reforms, including the introduction of mandatory reporting of antipsychotic use.Design: A retrospective cohort study using routinely collected electronic medication administration data.Setting and Participants: Daily medication administration data for 52,201 residents of 428 RAC facilities in 7 Australian states and territories between January 2018 and December 2022.Methods: We estimated the percentage of residents administered psychotropic medications from 4 classes (antipsychotics, sedatives and anxiolytics, antiseizure medication, antidepressants) at least once in each calendar month. The relative monthly average percentage change (RAPC) in prevalence by dementia status was the primary outcome.Results: Significant reductions occurred in the administration of antipsychotic, sedative and anxiolytic, and antiseizure medication to residents with and without dementia between 2018 and 2022. However, administration of antidepressants increased in residents with dementia over the same period. Residents with dementia experienced an RAPC of -34.6% (95% CI: -41.1, -28.2; P < .001) for antipsychotics, -38.5% (95% CI: -48.3, -28.7; P < .001) for sedatives and anxiolytics, -28.6% (95% CI: -38.1, -19.1; P < .001) for antiseizure medication, and 11.9% (95% CI: 5.44, 18.4; P < .001) for antidepressants. Residents without dementia experienced an RAPC of -31.7% (95% CI: -40.2, -23.1; P < .001) for antipsychotics, -35.3% (95% CI: -42.8, -27.9; P < .001) for sedatives and anxiolytics, -12.5% (95% CI: -20.2, -4.82; P < .001) for antiseizure medication, and no change for antidepressants.Conclusions and Implications: Between 2018 and 2022, use of 3 psychotropic medication classes declined in Australian RAC. However, antidepressant use increased in people with dementia, potentially as a form of chemical restraint. Ongoing monitoring of the national Quality Indicator program and other initiatives is crucial to ensure there are no unintended consequences such as switching between psychotropic medication classes.",

keywords = "Health care reform, health policy, medication therapy management, nursing homes, psychotropic drugs",

author = "Raban, {Magdalena Z.} and Bayzidur Rahman and Nasir Wabe and Ling Li and Elizabeth Manias and Mark Morgan and Tracey Bucknall and Cameron, {Ian D.} and Bell, {J. Simon} and Silva, {Sandun S.} and Rajendra Gyawali and Westbrook, {Johanna I.}",

note = "Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2025",

month = nov,

doi = "10.1016/j.jamda.2025.105832",

language = "English",

volume = "26",

pages = "1--7",

journal = "Journal of the American Medical Directors Association",

issn = "1525-8610",

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Raban, MZ , Rahman, B , Wabe, N , Li, L, Manias, E, Morgan, M, Bucknall, T, Cameron, ID, Bell, JS, Silva, SS , Gyawali, R & Westbrook, JI 2025, 'National aged care reforms and trends in psychotropic medication use in 428 residential age care facilities, 2018-2022', Journal of the American Medical Directors Association, vol. 26, no. 11, 105832, pp. 1-7. https://doi.org/10.1016/j.jamda.2025.105832

TY - JOUR

T1 - National aged care reforms and trends in psychotropic medication use in 428 residential age care facilities, 2018-2022

AU - Raban, Magdalena Z.

AU - Rahman, Bayzidur

AU - Wabe, Nasir

AU - Li, Ling

AU - Manias, Elizabeth

AU - Morgan, Mark

AU - Bucknall, Tracey

AU - Cameron, Ian D.

AU - Bell, J. Simon

AU - Silva, Sandun S.

AU - Gyawali, Rajendra

AU - Westbrook, Johanna I.

N1 - Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2025/11

Y1 - 2025/11

N2 - Objectives: To assess changes in the prevalence of psychotropic medication administration in Australian residential aged care (RAC) during a period of national reforms, including the introduction of mandatory reporting of antipsychotic use.Design: A retrospective cohort study using routinely collected electronic medication administration data.Setting and Participants: Daily medication administration data for 52,201 residents of 428 RAC facilities in 7 Australian states and territories between January 2018 and December 2022.Methods: We estimated the percentage of residents administered psychotropic medications from 4 classes (antipsychotics, sedatives and anxiolytics, antiseizure medication, antidepressants) at least once in each calendar month. The relative monthly average percentage change (RAPC) in prevalence by dementia status was the primary outcome.Results: Significant reductions occurred in the administration of antipsychotic, sedative and anxiolytic, and antiseizure medication to residents with and without dementia between 2018 and 2022. However, administration of antidepressants increased in residents with dementia over the same period. Residents with dementia experienced an RAPC of -34.6% (95% CI: -41.1, -28.2; P < .001) for antipsychotics, -38.5% (95% CI: -48.3, -28.7; P < .001) for sedatives and anxiolytics, -28.6% (95% CI: -38.1, -19.1; P < .001) for antiseizure medication, and 11.9% (95% CI: 5.44, 18.4; P < .001) for antidepressants. Residents without dementia experienced an RAPC of -31.7% (95% CI: -40.2, -23.1; P < .001) for antipsychotics, -35.3% (95% CI: -42.8, -27.9; P < .001) for sedatives and anxiolytics, -12.5% (95% CI: -20.2, -4.82; P < .001) for antiseizure medication, and no change for antidepressants.Conclusions and Implications: Between 2018 and 2022, use of 3 psychotropic medication classes declined in Australian RAC. However, antidepressant use increased in people with dementia, potentially as a form of chemical restraint. Ongoing monitoring of the national Quality Indicator program and other initiatives is crucial to ensure there are no unintended consequences such as switching between psychotropic medication classes.

AB - Objectives: To assess changes in the prevalence of psychotropic medication administration in Australian residential aged care (RAC) during a period of national reforms, including the introduction of mandatory reporting of antipsychotic use.Design: A retrospective cohort study using routinely collected electronic medication administration data.Setting and Participants: Daily medication administration data for 52,201 residents of 428 RAC facilities in 7 Australian states and territories between January 2018 and December 2022.Methods: We estimated the percentage of residents administered psychotropic medications from 4 classes (antipsychotics, sedatives and anxiolytics, antiseizure medication, antidepressants) at least once in each calendar month. The relative monthly average percentage change (RAPC) in prevalence by dementia status was the primary outcome.Results: Significant reductions occurred in the administration of antipsychotic, sedative and anxiolytic, and antiseizure medication to residents with and without dementia between 2018 and 2022. However, administration of antidepressants increased in residents with dementia over the same period. Residents with dementia experienced an RAPC of -34.6% (95% CI: -41.1, -28.2; P < .001) for antipsychotics, -38.5% (95% CI: -48.3, -28.7; P < .001) for sedatives and anxiolytics, -28.6% (95% CI: -38.1, -19.1; P < .001) for antiseizure medication, and 11.9% (95% CI: 5.44, 18.4; P < .001) for antidepressants. Residents without dementia experienced an RAPC of -31.7% (95% CI: -40.2, -23.1; P < .001) for antipsychotics, -35.3% (95% CI: -42.8, -27.9; P < .001) for sedatives and anxiolytics, -12.5% (95% CI: -20.2, -4.82; P < .001) for antiseizure medication, and no change for antidepressants.Conclusions and Implications: Between 2018 and 2022, use of 3 psychotropic medication classes declined in Australian RAC. However, antidepressant use increased in people with dementia, potentially as a form of chemical restraint. Ongoing monitoring of the national Quality Indicator program and other initiatives is crucial to ensure there are no unintended consequences such as switching between psychotropic medication classes.

KW - Health care reform

KW - health policy

KW - medication therapy management

KW - nursing homes

KW - psychotropic drugs

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U2 - 10.1016/j.jamda.2025.105832

DO - 10.1016/j.jamda.2025.105832

M3 - Article

C2 - 40882947

SN - 1525-8610

VL - 26

SP - 1

EP - 7

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

IS - 11

M1 - 105832

ER -

National aged care reforms and trends in psychotropic medication use in 428 residential age care facilities, 2018-2022

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