New reports shed light on seniors and antipsychotic medications
29 March 2017
By Benedicte Schoepflin
In the last few months, a number of reports and news stories have highlighted older people’s use of medications, and more specifically antipsychotics. We share what we have learned and how this is relevant for the project we recently launched on health care consent and aging.
In February, the Canadian Psychological Association celebrated Psychology Month to highlight the contribution of Canadian psychology and to let Canadians know how psychology works to help them live healthy lives. The Canadian Nurse magazine took the opportunity to think about psychology in numbers and published a few key statistics. For example, they reported that 6.7 million Canadians live with a mental health problem or illness at any given time, nearly 20 percent of the country’s population.
Meds and seniors in numbers
When it comes to older adults, a number of reports have highlighted some statistics worth reflecting on. In the United States, a new study released in February 2017 demonstrates that there has been a rise in the number of American seniors who take three or more medications that affect their brains. The study considered seniors’ use of opioid painkillers, antidepressants, tranquilizers and antipsychotic drugs.
A review of U.S. Centers for Disease Control and Prevention data shows that the use of these drugs in people over 65 more than doubled from 2004 to 2013. Researchers indicate this finding is a cause for concern as the combined use of drugs that act on the central nervous system can lead to falls, affect driving ability, and cause memory and thinking problems. Another finding of the study was that nearly half of seniors taking these drug combinations did not have a formal diagnosis of a mental health condition, insomnia or pain condition—the three main types of problems for which these drugs are typically prescribed.
This study resonates with findings in Canada, where seniors are the heaviest users of prescription medicines. A study from the Institute for Research on Public Policy released in January 2017 notes that on average, two-thirds of seniors take five or more prescription drugs over the course of a year and one-quarter take 10 or more. It is estimated that as much as half of the medications given to seniors are taken incorrectly or are overprescribed, increasing the likelihood of drug reactions and interactions, and without evidence they are safe and effective for them. The study calls for a comprehensive national strategy to address inappropriate prescribing practices that lead to the unsafe use of medications by seniors.
Another study led by Steve Morgan, a professor in the school of population and public health at the University of British Columbia, and published in 2016, found that the prescribing of potentially inappropriate medications for older adults is common and costly in Canada, especially for women.
In regards to the specific use of antipsychotic medications, a report released in February 2016 by the Canadian Institute for Health Information shows that in 2014, 39 per cent of seniors in long-term care facilities were prescribed at least one anti-psychotic and that nearly one-quarter of residents were chronic users of antipsychotic medications. Antipsychotics refer to a class of drugs used to control symptoms in patients with psychotic disorders such as schizophrenia and related disorders.
In 2015, a study led by Tara Gomes, a scientist at Li Ka Shing Knowledge Institute of St. Michael’s Hospital and the Ontario Drug Policy Research Network found that the use of anti-psychotic drugs by seniors in their homes and other community settings in Ontario had jumped by 26 percent in five years. Trends in the rate of antipsychotic use varied across provinces, with the rate decreasing slightly in B.C. and Ontario, while increasing in New Brunswick and P.E.I. For example, in facilities across B.C., an average of 27 percent of residents are taking antipsychotics without a matching psychiatric diagnosis, according to the 2017 Residential Care Facilities Quick Facts Directory, produced by the B.C. Seniors Advocate.
Antipsychotics and people living with dementia
The use of antipsychotics in seniors remains a complex question. People living with Azheimer disease and related dementia experience a range of symptoms. The symptoms include, but are not limited to, changes in mood, delusions and hallucinations, and responsive behaviours. Responsive behaviours, which may include agitation, aggression, and verbal outburst, can be particularly challenging for caregivers and can possibly result in incidents. In June 2016, the B.C. Seniors Advocate released a report focused on the issue of resident to resident aggression in BC’s care homes. Most of the incidents occurred in facilities with a high proportion of residents with complex care needs, and the report made specific recommendations on reporting, staffing levels, staff training and facility design and security systems.
To treat responsive behaviours, antipsychotics are commonly prescribed, and the Canadian Institute for Health Information report found that residents with severe cognitive impairment and those exhibiting highly aggressive behaviour were more likely to have used an antipsychotic.
However, the report also noted that the use of antipsychotics among residents without behavioural symptoms (about 20 percent) may suggest use contrary to treatment guidelines.
While there are cases where antipsychotic medications are warranted, most antipsychotic medications are not approved to treat dementia and can cause side effects that include sedation, a sudden drop in blood pressure, falls, fractures, stroke and death.
Some institutions in Canada and elsewhere are developing “person-centred” approaches which consider the needs of the residents first and are exploring non-drug therapies such as exercise, music, gardening, and pet therapy. The Canadian Institute for Health Information notes that a large proportion of seniors in long-term care facilities exhibiting severe aggression were not treated with antipsychotics, suggesting that non-drug alternatives were being considered, even in the most serious cases.
The right to health care consent
Whatever health treatment options are considered, people living with dementia and their substitute decision makers have a right to be consulted on medication choices. In collaboration with the Alzheimer Society of B.C., the Canadian Centre for Elder Law has launched a new project on the law, policy and practice with respect to health care consent in British Columbia.
Over the next few months, we will be holding consultation focus groups in communities across B.C. to learn about people’s experiences around consent to treatment and medication.
If you are a person living with dementia, a caregiver or substitute or supportive health care decision maker for a person living with dementia, you may be able to participate. Please contact us at: firstname.lastname@example.org.
Photos by Isabelle Groc