Antipsychotic use in long-term care homes still 'stubbornly high' despite a national target, doctor says
Listen to this articleEstimated 5 minutesThe audio version of this article is generated by AI-based technology. Mispronunciations can occur. We are working with our partners to continually review and improve the results.Nearly one in four long-term care residents in Canada were prescribed powerful antipsychotic drugs without a diagnosis of psychosis in 2024-2025, according to a new report that spotlights a worrying trend, seniors' health advocates say. Antipsychotic medications like Haldol and Risperidone were designed to manage symptoms like hallucinations in people with schizophrenia. The medications are also sometimes used to address symptoms like aggression in patients with dementia.But the drugs are highly sedating and inappropriate use "can carry serious risks, including adverse reactions, cognitive decline, falls and even death," the Canadian Institute for Health Information (CIHI) said in a report this week. The latest CIHI data shows the problem remains "stubbornly high" despite a national target to bring it down, said Dr. Samir Sinha, a geriatrician and clinician scientist at Sinai Health and Toronto's University Health Network, who was not involved in the report.The CIHI data suggests 24 per cent of long-term care residents in Canada were given an antipsychotic medication that may be unnecessary. "The numbers haven't been trending the right way," said Andrea Foebel, CIHI’s manager of indicator research and development in Ottawa.Rates of potentially inappropriate use ranged from 20 per cent in Ontario to 36 per cent in New Brunswick. Submitting statistics to CIHI is voluntary, and while not every home participates, the data includes a strong majority of 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 many jurisdictions across Canada were focused on reducing unnecessary antipsychotic use in their long-term care homes.During the pandemic, Foebel said priorities shifted, staffing shortages in nursing homes grew, residents were isolated to stem the spread of infection, which meant family members visited less often and routine services became disrupted. Since long-term care homes don't provide the reason why each person was prescribed the medication, Foebel and her team couldn't determine misuse, just potentially inappropriate use. The report's authors adjusted for factors beyond the control of homes, such as how many residents experience impaired decision-making.National target set to curb useThe monitoring lets LTCs know where they stand, for jurisdictions to learn from each other and realize what interventions are needed, Foebel said.Last year, the Appropriate Use Coalition, a group of Canadian health organizations, set a national target for long term care homes of 15 per cent or less. Hitting the target would have meant about 21,000 fewer people across the country receiving the potentially inappropriate drugs compared with the year before, CIHI said. Bringing antipsychotic use down matters, Sinha said, because the medications need to be prescribed with an abundance of caution given the risk of side effects. "What I can see from the data is that this remains a stubbornly high number," Sinha said. Side-effects of the medications can include movement disorders like parkinsonism or restlessness that sometimes can't be reversed, Sinha noted. The drugs carry a warning from Health Canada highlighting an association with increased risk of death as well as strokes, he added.Ways to cut back Nursing homes may turn to antipsychotic medications when a resident with dementia wanders and gets into altercations with others. But treating the underlying issues behind behaviours in someone with dementia, like pain, can help, Sinha said.Distracting the individual or just giving reassurance may also be enough, Sinha suggested. When those techniques don't work and the person is having distress, then long-term care home staff might consider antipsychotic medications, he said. Dr. Samir Sinha encourages long-term care homes to review their residents' antipsychotic medications every three months. (Tiffany Foxcroft/CBC)"We want to make sure that these medications aren't being inappropriately used for sedation, for example, or other things that could be treated with safer alternative medications."Sinha suggests staff at long-term care homes review their residents' medications every three months to see if it is still needed and if the dose is right. If not, then taper off the person from antipsychotic drugs. But the data for 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 age in place and transition to long-term care homes."We need to explore other models of care rather than thinking large nursing homes of 200 beds are the best place for people with dementia," Compton said.In an environment of a health-care system, Compton said staff often don't have quiet places for people to go when they need support and then anti-psychotics are prescribed.
