The Frequency of Antipsychotic Prescribing in Older People Mental Health Services: A Southern Health OPMH CRIS Audit

Abstract

Background: Antipsychotic prescription in older people with mental health problems can have severe adverse effects such as an increased risk of falls and show higher mortality rates. Moreover, this risk is elevated for the elderly with dementia. Aims: to provide an estimate of the frequency of antipsychotic use for mental health problems in older people mental health (OPMH) services and collect evidence of adherence to NICE guidelines. Methods: A retrospective clinical audit of typical and atypical antipsychotic medication use in OPMH services. A clinical Research Interactive Search (CRIS: 2007) was conducted from 1st January 2016 until 31st December 2017. This focused on patients referred to OPMH services that were being prescribed Flupentixol, Haloperidol, Prochloperazine, Amisulpride, Olanzapine, Quetiapine or Risperidone. Results: There were 1,642 (22.75%) patients prescribed one or more of the seven selected antipsychotics within the OPMH services. Of these patients without comorbid psychotic illness 1390 (84.6%) were prescribed an antipsychotic; the most common indications for such medication were agitation, psychotic symptoms, distress or aggression. This is 22.75% of the total number of people currently under OPMH services and is not limited to those of a specific disorder. The most commonly prescribed were atypicals and specifically Risperidone. The most common diagnosis prescribed antipsychotic medication was dementia 40%. Conclusions: These prescribing behaviours reveal good practice, in line with current NICE guidelines of what would be expected for the OPMH services. However, a further investigation into the rationale for the prescribing behaviour evident and the quality of alternative pharmacological and non-pharmacological approaches available to this population is essential.