Doctor says antipsychotic use in long-term care homes still ‘very high’ despite national target

Nearly one in four long-term care residents in Canada could be prescribed powerful antipsychotic drugs without a diagnosis of psychosis in 2024-2025, according to a new report, highlighting a worrying trend, seniors’ health advocates say.

Antipsychotic drugs such as Haldol and Risperidone were designed to manage symptoms such as hallucinations in people with schizophrenia. Medications are also sometimes used to address symptoms. attack In patients with dementia.

But these drugs are highly sedating and their improper use “can pose serious risks, including adverse reactions, cognitive decline, falls, and even death.” Canadian Institute for Health Information (CIHI) said in a report this week.

Latest CIHI data shows problem remains “very high” Despite the national goal of bringing it down, said Dr. Samir Sinha, a geriatrician and physician scientist at Mount Sinai Health and the University of Toronto Health Network, who was not involved in the report.

CIHI data shows that 24 per cent of long-term care residents in Canada were prescribed an antipsychotic medication that may be unnecessary.

“The data are not trending in the right direction,” said Andrea Foebel, manager of indicators research and development for CIHI in Ottawa.

Rates of potentially inappropriate use ranged from 20 percent in Ontario to 36 percent in New Brunswick. Submitting data to CIHI is voluntary, and although not every household participates, the data covers most facilities in the country.

The national rate was also higher than In the United States, Australia and Sweden.

Before the COVID-19 pandemic, CIHI’s analysis found that many jurisdictions across Canada were focused on reducing unnecessary antipsychotic use in their long-term care homes.

Foebel said priorities changed during the pandemic, as nursing home staffing shortages increased, residents were isolated to prevent the spread of infection, which meant family members visited less frequently and routine services were disrupted.

Because long-term care homes do not disclose the reason why each person was given the drug, Fobel and his team could not determine misuse, only potentially inappropriate use. The report’s authors adjusted for factors beyond households’ control, such as How many residents experience inability to take decisions?

National target set to curb use

Foebel said monitoring lets LTCs know where they stand, jurisdictions learn from each other and realize what interventions are needed.

Last year, the Appropriate Use Coalition, a group of Canadian health organizations, set a national target of 15 per cent or less for long-term care homes. CIHI said achieving the target would mean around 21,000 fewer people across the country would receive potentially inappropriate medicines than last year.

Sinha said, reducing the use of antipsychotics because the drugs need to be prescribed with great caution given the risk of side effects.

“What I can see from the data is that it continues to be a very large number,” Sinha said.

Sinha said side-effects of the drugs can include movement disorders such as parkinsonism or restlessness that sometimes cannot be reversed. He said these drugs have warnings from Health Canada, highlighting their association with an increased risk of death as well as stroke.

Deduction methods

Nursing homes may turn to antipsychotic medications when a resident suffering from dementia wanders off and gets into fights with others. But treating the underlying issues behind a man’s behaviorTia, like Pain, can help, Sinha said.

It may also be to divert the person’s attention or simply provide reassurance. Enough, Sinha suggested. When those techniques don’t work and the person is having trouble, long-term care home staff “I might consider antipsychotic medications,” he said.

“We want to make sure that these drugs are not being used inappropriately for sedation, for example, or other things that can be treated with safer alternative drugs.”

Sinha suggests that staff at long-term care homes review their residents’ medications every three months to see if they are still needed and if the dosage is correct. If not, keep the person off antipsychotic medications.

But data on long-term care homes isn’t one size fits all, said Roslyn Compton, executive director of Better LTC in Saskatoon. The not-for-profit helps seniors as they age and move into long-term care homes.

“We need to explore other models of care rather than thinking that big nursing homes with 200 beds are the best places for people with dementia,” Compton said.

In the health care system environment, Compton said staff often don’t have a quiet place for people to turn to when they need support and then be prescribed anti-psychotic medications.