Patterns and practices: A mixed methods investigation into psychotropic prescribing among UK care home residents

Alotaibi, Talal 2025. Patterns and practices: A mixed methods investigation into psychotropic prescribing among UK care home residents. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background: Many care home residents have dementia, with Alzheimer’s disease (AD) being the most common type. These individuals often experience behavioural and psychological symptoms of dementia (BPSD), such as depression and agitation, which frequently lead to care home admission. National Institute for Health and Care Excellence guidelines recommend non-pharmacological approaches for managing BPSD. However, treatment remains challenging, and psychotropic medications such as antidepressants are often prescribed, despite limited eKectiveness in people with dementia. Given the high prevalence of dementia and BPSD among care home residents, alongside the widespread use of psychotropic medications, the aim of this thesis is to investigate the prevalence and patterns of prescribing of psychotropic medications (particularly antidepressants, antipsychotics, and anxiolytics) among older adults living in UK care homes, including their use in the management of BPSD. Methods: A mixed-methods approach was used. A systematic review was conducted initially to understand how depression is treated pharmacologically in people with AD in care homes. Second, secondary pseudonymized electronic Medication Administration Record data were analysed to describe the characteristics of care home residents and their prescribed medications, with a focus on psychotropic medications. Third, psychotropic prescribing was compared between residents prescribed and not prescribed anti-dementia medications. Finally, care home staK were interviewed to understand their perspectives on the management of BPSD and the use of psychotropic medications, in residents with dementia in care homes. Results: Across 310 UK care homes, 9060 residents were included. 56.5% were prescribed at least one psychotropic medication, with 69% on a single type and 31% on combinations. Antidepressants (57%) were the most commonly prescribed psychotropic medication, followed by antipsychotics (26%) and anxiolytics (17%). A significant association was observed between anti-dementia and psychotropic medication prescribing, with 66% of residents prescribed anti-dementia medications also prescribed psychotropics, compared with 54% of those not prescribed anti-dementia medications. Among all residents, the prescribing of antidepressants alone (30.9% vs. 26.5%), anxiolytics alone (4.9% vs. 3.3%), and combinations of psychotropics (22.2% vs. 16.2%) was significantly higher among residents prescribed anti-dementia medications compared with those not prescribed such medications. Male residents and youngest-old residents (irrespective of gender) were more likely to be prescribed psychotropic medications than female and oldest-old residents, respectively, regardless of antidementia medication prescribing status. Interviews with two care home managers highlighted barriers to providing eKective treatment for residents with BPSD, leading care home staK to potentially rely more on psychotropic medications. Conclusions: The demographic data for the care home residents from this study are representative as they align with UK census data. Psychotropic medications were prescribed extensively in these care homes, with a marked increase among residents also prescribed anti-dementia medications, suggesting anti-dementia medications may iii be driving psychotropic prescribing, despite eKicacy and side eKect concerns. Age and gender also appear to influence prescribing patterns. Residents prescribed antidementia medications may exhibit more symptoms or lack medication reviews, leading to inappropriate prescribing. Therefore, it is important for prescribers to consider guidelines and other factors that might influence prescribing practices, particularly for those residents prescribed anti-dementia medications and thus likely to have AD.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Pharmacy
Subjects:	Q Science > Q Science (General)
Date of First Compliant Deposit:	24 March 2026
Last Modified:	24 Mar 2026 12:31
URI:	https://orca.cardiff.ac.uk/id/eprint/185919

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