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Atlas Focus Report: Antipsychotic medicines dispensing

This Australian Atlas of Healthcare Variation report examines PBS-subsidised antipsychotic medicines dispensing in people 65 years and over. The findings from our report help identify inappropriate or overuse of antipsychotic medicines and areas for improvement.

Key findings

11% decrease

in national dispensing rate

Dispensing rates were higher

in major cities than in regional or remote areas

Dispensing rates increased

with socioeconomic disadvantage

Report Summary

Rates of PBS-subsidised antipsychotic medicines dispensing for people aged 65 years and over between 2016–17 and 2020–21:

  • fell by 11%, possibly reflecting a wide range of initiatives to reduce inappropriate prescribing in older people with behavioural and psychological symptoms of dementia
  • were higher in major cities than in regional areas, and were lowest in remote areas
  • increased with socioeconomic disadvantage
  • decreased in geographic variation*, from 17-fold to 12-fold.

*Difference between the local area with the highest rate and the local area with the lowest rate

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What are antipsychotic medicines? 

Antipsychotic medicines are used to manage serious mental health conditions such as schizophrenia. Antipsychotic medicines may also be used to manage severe risk and distress and other acute behavioural disturbances related to dementia or delirium.

More than 90% of people with dementia experience some degree of behavioural and psychological symptoms of dementia (BPSD), such as agitation, aggression and psychosis (hallucinations and delusions).1 Antipsychotic medicines offer only small benefits in managing BPSD, with the effect less than some non-pharmacological treatments.2 They are associated with harms, including sedation, confusion, falls, pneumonia, hip fracture, reduced quality of life, stroke and death.3

Guidelines recommend that non-pharmacological strategies should be used to manage behavioural disturbances related to dementia or delirium before medicines are considered.4,5 Non-pharmacological strategies include social contact, environmental changes, psychological interventions, providing meaningful activities and addressing unmet needs, such as loneliness, boredom, fear, hunger, thirst and toileting.4 Pain can also be a major contributor to BPSD,6 so it is important to manage possible causes of pain, as well as constipation or acute medical problems.
 

Clinical commentary 

Antipsychotic medicines are an important management option for some people with severe BPSD.7,4 However, these medicines are often prescribed outside guideline recommendations,3 and without proper consent, monitoring or dose adjustment.8

Most prescribing of antipsychotic medicines for BPSD occurs in residential aged care facilities (RACFs),9,10 although use in the community is increasing.11 Concerns have been raised that antipsychotics may be used as a form of restrictive practice to manage BPSD in people living in RACFs.12

Around one in five people living in RACFs are prescribed at least one antipsychotic medicine.10,13 An Australian Department of Health expert clinical advisory panel estimated that psychotropic medicines, including antipsychotic medicines, are justified in only 10% of cases in residential aged care.14

The First Australian Atlas of Healthcare Variation15 found that almost 1 million (919,026) PBS prescriptions for antipsychotic medicines were dispensed for people aged 65 years and over in 2013–14. The number of prescriptions dispensed was nearly eight times higher in the area with the highest rate compared to the area with the lowest rate.1

The Third Australian Atlasof Healthcare Variation found that dispensing rates for people aged 65 years and over fell by 6% between 2013–14 and 2016–17. However, geographic variation increased: the difference between the local area with the highest rate and the local area with the lowest rate was 8-fold in 2013–14, compared to 16-fold in 2016–17.2 This might indicate change in antipsychotic use in some areas of Australia but not in others.

Given the increase in geographic variation between 2013–14 and 2016–17, a continued focus on reporting rates of antipsychotic medicines dispensing is warranted.

This report examines Pharmaceutical Benefits Scheme (PBS) medicines dispensing for people aged 65 years and over, between 2016–17 and 2020–21.

The report presents national data, and data by state and territory, Primary Health Network (PHN) and local area (Statistical Area Level 3; SA3).

This report presents interactive data visualisations for:

  • Australia and its states and territories
  • Remoteness and socioeconomic status levels
  • Primary Health Networks (PHNs)
  • Local areas (SA3s)

Data are sourced from the PBS dataset. This dataset includes all prescriptions dispensed under the PBS or the Repatriation Pharmaceutical Benefits Scheme (RPBS). The dispensing of a medicine does not always mean the medicine is consumed. Some medicines may not be taken after dispensing or people may stop taking them.

National trends
  • There was an 11% fall in the antipsychotic medicines dispensing rate – that is, the number of prescriptions dispensed per 100,000 people aged 65 years and over.
  • There was a 13% fall in the number of people aged 65 years and over per 100,000 people who had at least one PBS antipsychotic medicine dispensed.
  • There was a 5% fall in the overall volume of antipsychotic medicines supplied on any given day to people aged 65 years and over, as measured by the Australian rate of defined daily doses dispensed per 1,000 people per day. (Defined daily dose is the assumed average maintenance dose per day for a drug used for its main indication in adults.)
  • There was a 22% reduction in geographic variation: in 2020–21, there was a 12-fold difference between the local area with the highest rate and the local area with the lowest rate, compared to 2016–17, when there was a 17-fold difference.
State and territory trends
  • Antipsychotic medicines dispensing rates fell in all states and territories. The largest fall was in the Northern Territory (30%) and the smallest fall was in the Australian Capital Territory (8%).
  • Victoria had the highest rate of any state and territory in both 2016–17 (29,840 prescriptions dispensed per 100,000 people) and 2020–21 (26,250 prescriptions dispensed per 100,000 people).
  • The Northern Territory had the lowest rate of any state and territory in both 2016–17 (17,149 prescriptions dispensed per 100,000 people) and 2020–21 (11,931 per 100,000 people).
Prescriber type
  • The proportion of geriatricians and psychiatrists prescribing antipsychotic medicines remained around the same, but the proportion of GPs prescribing antipsychotics fell (89% to 84%).
  • The proportion of ‘other professionals’ prescribing antipsychotic medicines increased (2% to 7%). Nurse practitioners were the largest group of ‘other professionals’.
Remoteness
  • Dispensing rates were higher in major cities than in regional areas; rates were lowest in remote areas for each of the five years.
Socioeconomic status
  • Dispensing rates increased with socioeconomic disadvantage for each of the five years.
Primary Health Networks (PHNs)
  • Dispensing rates fell in all PHNs over the five-year period.
  • North Western Melbourne PHN in Victoria had the highest PHN rate in both 2016–17 (33,517 prescriptions dispensed per 100,000 people) and 2020–21 (28,610 prescriptions per 100,000 people).
  • The Northern Territory had the lowest PHN rate in both 2016–17
    (17,149 per 100, 000 people) and 2020–21 (11,899 per 100,000 people).
Consistently high and low local areas

Local areas (SA3s) with consistently high antipsychotic medicines use are those areas with dispensing rates in the top 10% for each of the five years.

  • 20 of the 340 SA3s in Australia had consistently high rates.
  • All 20 were in major cities (in New South Wales, Victoria, Queensland, South Australia and the Australian Capital Territory).
  • 8 of the 20 were areas of socioeconomic disadvantage (lowest two SES quintiles).
  • Leichhardt in New South Wales was the only consistently high local area that reduced dispensing rates each year for five years.
  • SA3s with consistently low antipsychotic medicines use are those areas with rates in the bottom 10% for each of the five years.
  • 12 out of the 340 SA3s in Australia had consistently low rates.
  • Of these 12, four were in remote areas, three were in outer regional areas, three were in inner regional areas and two were in major cities.
  • Seven of the 12 were in areas of socioeconomic disadvantage (lowest two SES quintiles).

The 11% fall nationally in the antipsychotic medicines dispensing rate for people aged 65 years and over between 2016–17 and 2020–21 continued the downward trend seen in the Third Atlas. 

The data also show a small but consistent reduction in the overall volume of antipsychotic medicines used compared to the data from the Third Atlas. There was a 22% reduction in geographic variation.

It is not known whether the fall in antipsychotic medicines dispensing for older people has been accompanied by an increase in the use of other psychotropic medicines such as sedating antidepressants and benzodiazepines.

It is also not known if there has been a switch to prescribing antipsychotic medicines on private prescriptions, which are not included in the PBS data.

The higher rate in Victoria was also noted in the First Atlas. The reasons for this higher rate are uncertain. Victoria has a higher proportion of public sector RACFs than other states16 and there is evidence of high rates of PRN (as needed) prescribing in Victorian public RACFs.17 However, it is not known if these characteristics or others contribute to the higher rates.

The lower rates of antipsychotic medicines dispensing in the Northern Territory may be because PBS data do not capture medicines that are supplied through remote Aboriginal health services.

Efforts to reduce the inappropriate use of antipsychotic medicines in older people in Australia have included legislative changes, guidelines, safety warnings, education and policy changes.18

The Australian Commission on Safety and Quality in Health Care (the Commission) has had a sustained focus on antipsychotic medicines dispensing, including reporting rates in the Atlas series and recommending and implementing actions to improve the appropriateness of antipsychotic medicines use.18

Initiatives and reforms aimed at reducing the inappropriate use of antipsychotic medicines in older people over the past five years are discussed below.

Government review and reform

The Royal Commission into Aged Care Quality and Safety (the Royal Commission) was established in 2018 and released its final report in March 2021, near the end of data period of this report.19 Media reporting of the background papers, hearings and the Commission’s Interim Report may have contributed to the reduction in antipsychotic use seen in the time series data.20

There is evidence that legislation appears to have the greatest impact on the inappropriate prescribing of antipsychotics medicines for people with BPSD.21,22

The Royal Commission Interim Report identified widespread use of “chemical restraints” in RACFs.14 In response, the Australian Government moved to protect people living in RACFs from the inappropriate use of physical and chemical restrictive practices through amending the Quality of Care Principles in 2019. For the first time, providers had to satisfy requirements before using any form of restrictive practice, including that alternatives had been tried, that the least restrictive form was used, and that informed consent from the person or their substitute decision-maker had been obtained. Changes to the Aged Care Act 1997 in July 2021 built on these changes,23 including requiring residential aged care providers to have a behaviour support plan for each consumer who requires the use of restrictive practices as part of their care.24

Standards and guidelines

There has been a range of work in standards and guidelines that emphasise the use of non-pharmacological strategies as first-line management of BPSD.

In 2016, the Australian and New Zealand Society for Geriatric Medicine recommended against the use of antipsychotic medicines as the first choice to manage BPSD.25

Also in 2016, the Commission released the Delirium Clinical Care Standard to improve the prevention of delirium in people at risk and the management of people with delirium.5 Updated in 2021, it recommends that non-pharmacological strategies should be used to manage a person with BPSD.5

Prescribing changes

Changes to prescribing rules may have contributed to the reduction in the use of antipsychotic medicines. Risperidone is the only antipsychotic medicine subsidised on the PBS for the management of BPSD. In 2015, the Therapeutic Goods Administration (TGA) limited the recommended duration of treatment with risperidone to 12 weeks for people with Alzheimer’s only (moderate to severe) and only after non-pharmacological interventions had failed.26 The PBS authority listing for risperidone was changed to align with this indication. The changes were followed by a 22% fall in the use of risperidone subsidised for dementia in people aged 65 years and over.3 A PBS change in January 2020 allowed risperidone to be prescribed on authority for longer than 12 weeks for people with Alzheimer’s disease who have BPSD.27

There may have been an increase in off-label private prescriptions for antipsychotic medicines in response to the increased prescribing restrictions. Two antipsychotic medicines, olanzapine and quetiapine, have gone off-patent28 in recent years, reducing the cost of private prescriptions.

Quality improvement and education programs

Multidisciplinary quality improvement programs in RACFs are effective in reducing the inappropriate use of antipsychotic medicines in older people,13 and may have contributed to the decrease observed in the data.

A prominent example in Australia is the RedUSe (Reducing Use of Sedatives in residential aged care facilities) program, which aims to reduce prescribing of antipsychotic medicines and benzodiazepines in RACFs.13 The program includes medication audit and feedback, staff education and interdisciplinary case review.

Implemented in 150 RACFs around Australia, RedUSe achieved significant reductions in antipsychotic and benzodiazepine prescribing without substitution by other psychotropic medicines. After six months, the medicines were stopped, or doses reduced, in almost 40% of people living in RACFs who were prescribed these medicines.13

National programs in education and quality improvement that may have reduced the inappropriate use of antipsychotic medicines include the following:

  • NPS MedicineWise implemented a national program between December 2020 and December 2021 that highlighted the importance of non-pharmacological options for people with dementia experiencing changed behaviours. The program trained GPs, nurse champions and pharmacists in 1,000 RACFs on best practice, person-centred care for people with dementia and provided a range of resources and tools for health professionals, consumers and carers.29
  • The Commission implemented medication safety programs for antipsychotic medicines, and resources and programs for health services, clinicians and consumers to address the inappropriate use of antipsychotics. These include the Better Way to Care series and consumer factsheets summarising issues and strategies. The Commission also developed guidance on the best practice use of antipsychotic medicines and other psychoactive medicines in managing cognitive impairment.
  • The Aged Care Quality and Safety Commission implemented a range of initiatives for residential aged care providers, health professionals and consumers to increase awareness of best practice in the management of BPSD. These include setting up a Behaviour Support and Restrictive Practices Unit, pharmacist educational visits in remote and rural areas, and a tool for residential aged care providers to oversee the use of psychotropic medications in residents. The Aged Care Quality and Safety Commission is also collaborating with the Older Persons Advocacy Network to educate consumers and their families about restraint, behaviour support and informed consent.

Although these findings are encouraging, a continued focus on reducing the inappropriate prescribing of antipsychotic medicines is warranted. All Government-subsidised RACFs have had to report on antipsychotic medicines use since July 2021 as part of the National Aged Care Mandatory Quality Indicator Program.30 The first data from this program showed that 22% (or around 36,000) people living in residential aged care received antipsychotics in July to September 2021, but around half of these people did not have a diagnosis of psychosis.30

The Commission is working with the Aged Care Quality and Safety Commission and the National Disability Insurance Scheme Quality and Safeguards Commission to reduce the inappropriate use of antipsychotic medicines.31 The Commission has also developed a Clinical Care Standard on the use of Psychotropic Medicines in Cognitive Disability or Impairment for managing behaviour that will support continued improvement across the disability, aged care and healthcare sectors.

Initiatives that have come from Royal Commission recommendations may help to reduce inappropriate prescribing of antipsychotic medications in older people. These include the following.

Standards

The Commission has developed the clinical care components of the Aged Care Quality Standards that includes medication safety, including the appropriate prescribing of antipsychotic medicines.

Quality indicators

Although it is too soon to know the impact of the National Aged Care Mandatory Quality Indicator Program, which included reporting of antipsychotic use since July 2021,30,32 evidence from Canada indicates public reporting of antipsychotic medicines use may reduce inappropriate prescribing.21

Education

The Royal Commission found “overwhelming evidence” of a lack of knowledge among personal care workers, nurses and GPs about the impact of restraints and the safe and appropriate management of BPSD.14

Further work to upskill the aged care workforce, including GPs, registered and enrolled nurses and assistants in nursing, in both dementia care and non-drug management techniques for BPSD, is needed to further reduce the inappropriate use of antipsychotic medicines. This is in line with the Royal Commission’s recommendation that aged care workers should do regular training in dementia care.33

Two Dementia Support Australia programs focus on education and support for behavioural interventions. The Dementia Behaviour Management Advisory Service and the Severe Behaviour Response Team, which provide information, clinical advice, assessment and short-term case management interventions, have been found to improve BPSD and caregivers’ distress.34 A state example is Primary Health Tasmania’s work to develop a suite of resources for clinicians and consumers about de-prescribing medicines, including antipsychotic medicines.

Models of GP care

Initiatives that facilitate continuity of care, time for review, patient-centred care and opportunities for a team approach in RACFs may reduce inappropriate prescribing of antipsychotic medicines. An Australian study found rates of dispensing of psychotropic medicines were higher for people with dementia who changed GP when they entered an RACF.35 The authors concluded that facilitating continuity of GP care for new residents and more structured transfer of GP care may prevent potentially inappropriate initiation of psychotropic medicines.35

The Royal Commission recommended that the Australian Government should trial and implement a new model of primary care in which general practices may choose to apply to become accredited aged care general practices.36

Medication Advisory Committees

The Australian Government recommends that each RACF should establish or have access to a Medication Advisory Committee, which can improve the quality use of medicines in RACFs.37 Following recommendations from the Fourth Australian Atlas of Healthcare Variation, the Commission is involved in developing a user guide on the role of Medication Advisory Committees in RACFs.

Appropriate management of BPSD in the community

Changes to improve the use of antipsychotic medicines in aged care facilities do not cover the use of these medicines for people with BPSD living in their own home. Work is needed to support appropriate use of antipsychotic medicines in this group.14

As well as the actions above, members of the expert advisory group for this report have proposed a variety of options to support the appropriate use of antipsychotic medicines in RACFs.

Workforce:
  • Ensure adequate staff levels in aged care facilities to allow staff enough time to use non-pharmacological strategies for BPSD
  • Increase involvement of specialist geriatricians, such as through funded positions on Medication Advisory Committees, more visits and telehealth consultations
  • Create new funding models for diversional therapists, psychologists and social workers to work in RACFs
  • Establish new GP incentive payments that are not linked to practices (GPs who are not part of a practice do not receive Practice Incentive Payments for visits to RACFs)
  • Increase engagement with PHNs in education and best practice.
Medication monitoring and reviews:
  • Improve the role of pharmacists in education, monitoring and de-prescribing
  • Increase frequency of pharmacist-conducted medication reviews
  • Allow nurse practitioners to conduct medication reviews and nurses to attend 12-week reviews
  • Monitor therapeutic substitution for antipsychotic medicines
  • Improve communication between prescribers, GPs and consumers to clarify who is responsible for medication review and de-prescribing.
Environment:
  • Enhance environments in RACFs, such as creating wandering areas and reducing excess noise, people and clutter.
Consumers:
  • Empower residents and families to ask nurses and doctors about minimising use of antipsychotics and other sedatives
  • Strengthen avenues for complaint where best practice is not occurring.

About the data

Data used in this report exclude doctors’ bag items and any programs with alternative supply arrangements, such as direct supply to remote Aboriginal health services.

The PBS and RPBS do not cover medicines supplied to public hospital inpatients, over-the-counter medicines and private prescriptions. The data include prescriptions to patients on discharge from hospital and to outpatients in most states and territories, except in New South Wales and the Australian Capital Territory.

Data are reported according to where people live, not where the prescription was written or dispensed. 

The data are age- and sex-standardised to allow comparisons between geographic areas with different age and sex structures.

For more information about the data, see the Technical Note.

Tools and resources 

Aged Care Quality and Safety Commission

  1. Therapeutic Guidelines. Introduction to dementia. In: Therapeutic Guidelines [digital]. Melbourne: Therapeutic Guidelines Limited; 2021 [Available from: https://tgldcdp.tg.org.au/viewTopic?topicfile=dementia#toc_d1e47].
  2. Royal Australian and New Zealand College of Psychiatrists. Professional Practice Guideline 10, Antipsychotic medications as a treatment of behavioural and psychological symptoms of dementia. Melbourne: RANZCP; 2016.
  3. Australian Commission on Safety and Quality in Health Care. Vital Signs 2017: The state of safety and quality in Australian health care. Sydney: ACSQHC; 2017.
  4. Therapeutic Guidelines. Role of pharmacological management for acute behavioural disturbance in older people. In: Therapeutic Guidelines [Digital]. Melbourne: Therapeutic Guidelines Limited; 2021 [Available from: https://tgldcdp.tg.org.au/viewTopic?topicfile=pharmacological-acute-behavioural-disturbance-older-people].
  5. Australian Commission on Safety and Quality in Health Care. Delirium Clinical Care Standard (revised). Sydney: ACSQHC; 2021.
  6. Atee M, Morris T, Macfarlane S, Cunningham C. Pain in dementia: prevalence and association with neuropsychiatric behaviors. J Pain Symptom Manage. 2021;61(6):1215-26.
  7. Guideline Adaptation Committee. Clinical practice guidelines and principles of care for people with dementia. Sydney: NHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People; 2016.
  8. Westaway K, Sluggett J, Alderman C, Moffat A, Procter N, Roughead E. The extent of antipsychotic use in Australian residential aged care facilities and interventions shown to be effective in reducing antipsychotic use: A literature review. Dementia (London). 2020;19(4):1189-202.
  9. Macfarlane S, Cunningham C. Limiting antipsychotic drugs in dementia. Aust Prescr. 2021;44(1):8-11.
  10. Harrison SL, Sluggett JK, Lang C, Whitehead C, Crotty M, Corlis M, et al. The dispensing of psychotropic medicines to older people before and after they enter residential aged care. Med J Aust. 2020;212(7):309-13.
  11. Tumusiime WA, Hardman CJ, Breen JL. Antipsychotic prescribing in people admitted to hospital with dementia or delirium. Australas J Ageing. 2022;41(2):258-64.
  12. Royal Commission into Aged Care Quality and Safety. Restrictive practices in residential aged care in Australia. Background Paper 4. Canberra; 2019.
  13. Westbury JL, Gee P, Ling T, Brown DT, Franks KH, Bindoff I, et al. RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities. Med J Aust. 2018;208(9):398-403.
  14. Royal Commission into Aged Care Quality and Safety. Interim Report: Neglect. Canberra: Commonwealth of Australia; 2019.
  15. Performance ACoSaQiHCaNH, Authority. Australian Atlas of Healthcare Variation. Sydney: ACSQHC; 2015.
  16. Department of Health Victoria. Public sector residential aged care services Melbourne: Victorian Government; 2015 [Available from: https://www.health.vic.gov.au/residential-aged-care/public-sector-residential-aged-care-services].
  17. Picton L, Ilomaki J, Keen CS, Lalic S, Adams B, Clinnick LM, et al. Rates of PRN medication administration in Australian residential aged care. J Am Med Dir Assoc. 2021;22(1):117-23 e1.
  18. Australian Commission on Safety and Quality in Health Care. Third Australian Atlas of Health Care Variation. Sydney: ACSQHC; 2018.
  19. Pagone T, Briggs L. Royal Commission into Aged Care Quality and Safety Final Report: Care, Dignity and Respect. Canberra: Commonwealth of Australia; 2021.
  20. Ivers NM, Taljaard M, Giannakeas V, Reis C, Williams E, Bronskill S. Public reporting of antipsychotic prescribing in nursing homes: population-based interrupted time series analyses. BMJ Qual Saf. 2019;28(2):121-31.
  21. Walker K, Shearkhani S, Bai YQ, McGilton KS, Berta WB, Wodchis WP. The impact of the Long-term Care Homes Act and public reporting on physical restraint and potentially inappropriate antipsychotic use in Ontario's long-term care homes. J Gerontol A Biol Sci Med Sci. 2020;75(4):813-9.
  22. Langford AV, Chen TF, Roberts C, Schneider CR. Measuring the impact of system level strategies on psychotropic medicine use in aged care facilities: A scoping review. Res Social Adm Pharm. 2020;16(6):746-59.
  23. Aged Care Quality and Safety Commission. Regulation of restrictive practices and the role of the senior practitioner, restrictive practices. Regulatory Bulletin: ACQSC; 2021.
  24. Aged Care Quality and Safety Commission. Behaviour support plans: A fact sheet for residential aged care providers. ACQSC; 2021.
  25. Australian and New Zealand Society for Geriatric Medicine. Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia Sydney: NPS MedicineWise; 2016 [Available from: https://www.choosingwisely.org.au/recommendations/anzsgm1.
  26. Pharmaceutical Benefits Scheme. Public summary document November 2015 PBAC Meeting - Risperidone. Canberra: Australian Government Department of Health; 2015 [Available from: www.pbs.gov.au/industry/listing/elements/pbac-meetings/psd/2015-11/files/risperidone-psd-november-2015.pdf].
  27. NPS MedicineWise. Risperidone: Revised PBS restrictions for behavioural and psychological symptoms of dementia Sydney: NPS MedicineWise; 2020 [Available from: https://www.nps.org.au/radar/articles/risperidone-revised-pbs-restrictions-for-behavioural-and-psychological-symptoms-of-dementia.
  28. Brett J. Concerns about quetiapine. Australian Prescriber. 2015;38:95-7.
  29. NPS MedicineWise. Together with consumers - NPS MedicineWise Annual Report 2021. Sydney: NPS MedicineWise; 2021.
  30. Australian Institute of Health and Welfare. Residential aged care quality indicators quarterly update (July to September 2021) Canberra: AIHW; 2022 [Available from: https://www.gen-agedcaredata.gov.au/www_aihwgen/media/2021-22-Quality-Indicators/RACS-QI-report-July-to-September-2021-previous-releases.pdf].
  31. Australian Commission on Safety and Quality in Health Care, Aged Care Quality and Safety Commission, NDIS Quality and Safeguards Commission. Joint Statement on the Inappropriate Use of Psychotropic Medicines 2022 [Available from: /node/1976].
  32. Australian Institute of Health and Welfare. Quality in aged care Canberra [Available from: https://www.gen-agedcaredata.gov.au/Topics/Quality-in-aged-care].
  33. Royal Commission into Aged Care Quality and Safety. Final Report - List of Recommendations. Canberra: Commonswealth of Australia; 2021 [Available from: https://agedcare.royalcommission.gov.au/publications/final-report-list-recommendations
  34. Macfarlane S, Atee M, Morris T, Whiting D, Healy M, Alford M, et al. Evaluating the clinical impact of national dementia behaviour support programs on neuropsychiatric outcomes in Australia. Front Psychiatry. 2021;12:652254.
  35. Welberry HJ, Jorm LR, Schaffer AL, Barbieri S, Hsu B, Harris MF, et al. Psychotropic medicine prescribing and polypharmacy for people with dementia entering residential aged care: the influence of changing general practitioners. Med J Aust. 2021;215(3):130-6.
  36. Department of Health. Australian Government response to the Parliamentary Joint Committee on Human Rights report on the Quality of Care Amendment (Minimising the Use of Restraints) Principles2019. Canberra: Australian Government Department of Health; 2020 [Available from: https://www.health.gov.au/resources/publications/regulations-restricting-the-use-of-restraints-in-residential-aged-care-services
  37. Department of Health and Ageing. Guiding principles for medication management in residential aged care facilities. Canberra: Australian Government Department of Health and Ageing; 2012.

Last updated: 13 March 2026