Public Summary: Drug Trends in LTC
February 25, 2016 — Despite the known health risks of antipsychotics, 39% of residents in long-term care (LTC) facilities were prescribed an antipsychotic at least once in 2014. This is the finding of a new report released by the Canadian Institute for Health Information (CIHI) — Use of Antipsychotics Among Seniors Living in Long-Term Care Facilities, 2014 — that looks at the overall use of these drugs (including cases where use may be appropriate). Antipsychotics are often prescribed to seniors to treat symptoms of dementia, such as aggression and agitation, as well as schizophrenia and other psychoses, but they can have harmful side effects.
The study also found that antipsychotic use was highest among residents with severe cognitive impairment and those exhibiting highly aggressive behaviour. However, the rate of use among seniors exhibiting highly aggressive behaviours (51.3%) suggests that even in the most severe cases, where residents or caregivers may be at risk of harm, non-drug treatment options are being considered.
“There are a number of initiatives across the country that have been successful in decreasing the use of antipsychotics in LTC,” said Jordan Hunt, manager of Pharmaceuticals at CIHI. “While there is still room for improvement, a lot of work has been done.”
Success stories include the following:
- The Canadian Foundation for Healthcare Improvement (CFHI) has helped more than 50 LTC facilities in Canada implement patient-centred and data-driven solutions to care for residents with dementia.
- For example, between 2010 and 2014, the use of antipsychotics in LTC facilities in Manitoba fell from about 38% to 31.5%. During this time, the Winnipeg Regional Health Authority participated in CFHI’s Executive Training for Research Application Program, which encouraged front-line staff to work together to implement creative solutions to manage dementia behaviours, with medication to be used only as a last resort.
Trends in antipsychotic use
Risperidone, which has a very narrow approved use for the treatment of symptoms of dementia in seniors, is the second most commonly prescribed drug for this purpose (14%). Quetiapine, which is not approved to treat symptoms of dementia in Canada, is the most commonly used antipsychotic, used by 19% of residents.
The use of antipsychotics with other psychotropic drugs increases the risk of side effects, including falls. Among 22% of residents regularly taking antipsychotics, nearly two-thirds (64%) were taking a regular antidepressant, and approximately 1 in 6 residents were also regularly taking a benzodiazepine, which can increase the risk of side effects.
A look at antipsychotics in Canada
This CIHI study takes a unique look at the overall use of antipsychotics in LTC, using both drug claims data and long-term care resident assessment data for its analysis. Studying the use of antipsychotics in LTC facilities provides important insight on where the problems lie and where further work needs to be targeted.
CIHI also publishes data on potentially inappropriate use of antipsychotics in LTC; the results are available at the provincial, regional and facility levels in our Your Health System: In Depth web tool.