Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 12;26(11):105832.
doi: 10.1016/j.jamda.2025.105832. Online ahead of print.

National Aged Care Reforms and Trends in Psychotropic Medication Use in 428 Residential Age Care Facilities, 2018-2022

Magdalena Z Raban  1 , Bayzidur Rahman  2 , Nasir Wabe  2 , Ling Li  2 , Elizabeth Manias  3 , Mark Morgan  4 , Tracey Bucknall  5 , Ian D Cameron  6 , J Simon Bell  7 , Sandun S Silva  2 , Rajendra Gyawali  2 , Johanna I Westbrook  2
Affiliations
Free article

National Aged Care Reforms and Trends in Psychotropic Medication Use in 428 Residential Age Care Facilities, 2018-2022

Magdalena Z Raban et al. J Am Med Dir Assoc. .
Free article

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.

PubMed Disclaimer

Conflict of interest statement

Disclosure M.R. and J.I.W. have received grant funding from the Australian Commission on Safety and Quality in Health Care. J.I.W. receives fees for teaching from Harvard University, as a codirector of the Safety, Quality, Informatics & Leadership Program. M.M. receives payment for consultancy services from Royal Australian College of General Practitioners, Primary Health Networks, Department of Health and Aged Care, and Australian Health Policy Collaboration of Victoria University. J.S.B. had received research grant or consulting funds from the Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organizations unrelated to this work. All grants and consulting funds were paid to the employing institution.

LinkOut - more resources