Misuse of Anti-Psychotic Medication in Long-Term Care Facilities

Antipsychotic medications are often prescribed for residents to control the behavioural symptoms of dementia – even for patients who do not have a concurrent psychiatric diagnosis. In fact, one study suggests that over one-quarter (27.5%) of residents in Long Term Care (LTD) facilities across Canada are wrongly dosed with antipsychotics i.e. without a diagnosis of psychosis.Just like anything in life, not every LTC facility is the same. Some administer antipsychotics to 67% of their residents, while others do not administer any. The strongest predictor of whether a resident will be a administered an anti-psychotic is not whether they have a psychosis, it is the average prescribing rate of their LTC facility.

One study concluded: “Residents residing in facilities with the highest antipsychotic prescribing rates were almost 3 times more likely to be prescribed [an antipsychotic] compared with similar residents in facilities with the lowest antipsychotic prescribing rates”.

Some facilities favour antipsychotic medication because it placates their residents and reduces the load on staff. “While sometimes necessary, these are very serious drugs with serious side effects” explains Wanda Morris, VP of Advocacy at CARP. “They increase the risk of stroke, heart disease, diabetes, pneumonia, falls and increase the likelihood of death”. They also impact quality of life and make it difficult, or impossible, for residents to communicate with loved ones.

Facilities should first attempt non-drug interventions to treat behaviour symptoms of residents. “Sometimes a resident is in pain or hungry for example,” says Morris. “Ensuring a patient’s comfort can significantly reduce behavioural symptoms and decrease the need for the unnecessary prescribing of antipsychotics”.

A recent initiative involving most of the provinces was implemented to reduce the rate of inappropriately prescribed antipsychotic medication. The facilities adopted a team-based, data-driven and patient-centre approach that focused on managing behaviours. The results were telling – the program reduced or eliminated the use of antipsychotic medication for over half of participating residents. And, aggressive behaviours actually decreased by 20%.

“This initiative is promising,” says Morris. “The real challenge will be to introduce this initiative to every facility across Canada. There will be resistance. The status quo is a powerful thing and there are facilities and healthcare professionals who are unwilling, or perhaps unable, to change their view on the necessity of antipsychotics”.

As prescription rates decline, we must be careful other medications are not simply taking their place. According to a recent study,[i] reductions in prescription rates for a common anti-psychotic medication are offset by increases in prescribing rates of low-dose, off-label anti-psychotic medications.

This issue is of critical importance for CARP members for themselves, their families and their loved ones. CARP believes aggressive action is needed now to eliminate unnecessary medication that harms our most vulnerable Canadians.

[1] (30 May 2016). Changing Pattern of Sedative Use in Older Adults: A Population-Based Cohort Study. Drugs & Aging. Springer International Publishing.