A recent study by researchers at the University of Waterloo has shed light on a concerning issue within nursing homes across Canada. Analyzing data from nearly 500,000 Canadian patients residing in nursing homes between 2000 and 2022, the study revealed that those given antipsychotic medications experienced a significant deterioration in their behaviors. In fact, nearly 68 percent of residents taking antipsychotics had more behavioral problems during follow-up evaluations.
“This is the first national longitudinal study of its kind, using a statistical technique to measure the effect of antipsychotic treatments,” said Dr. Daniel Leme, the lead author and a postdoctoral scholar in Waterloo’s School of Public Health Sciences.
Antipsychotics are frequently prescribed “off-label” in nursing homes. This means they are used for purposes not approved by health authorities such as the U.S. Food and Drug Administration (FDA). For instance, they may be administered to manage behaviors linked to dementia, despite being approved only for treating conditions like schizophrenia or specific types of psychosis. The study found that 26 percent of nursing home residents in Canada were given antipsychotics in ways not recommended by the FDA between 2014 and 2020.
While these medications are often used with the intention of calming aggressive or agitated residents, they can come with serious side effects. These include tremors, restlessness, rigidity, painful muscle contractions, and difficulties with standing and walking, all of which can exacerbate existing behavioral and psychological symptoms.
“Sometimes people may say they don’t have enough staff to deal with these issues, but the reality is that these medications can make disability and cognitive impairment worse,” stated Dr. John Hirdes, a professor in the School of Public Health Sciences. “We need to seriously reconsider the use of antipsychotics for people who do not have conditions associated with psychosis.”
The study also highlights the inappropriate use of antipsychotics to treat the behavioral and psychological symptoms of dementia (BPSD), which can encompass irritability, aggression, agitation, anxiety, depression, sleep or appetite changes, apathy, wandering, repetitive questioning, sexually inappropriate behaviors, and refusal of care.
Rather than immediately resorting to medication, researchers propose focusing on person-centered care. This involves getting to the root causes of a resident’s behavior and providing support through alternative means. For example, a resident might benefit from improved pain management, clearer communication, or activities aimed at reducing anxiety. Non-drug therapies like music, art, social interaction, and gentle exercise have been shown to effectively manage behavior without the need for antipsychotics.
Moreover, training staff to understand the risks associated with antipsychotics and how to offer better care has been linked to improved outcomes for nursing home residents, including reduced agitation and a better quality of life.
The study, published in the November 2024 issue of the Journal of the American Medical Directors Association, is part of an international project called I-Care4Old and was funded by the New Frontiers Research Fund Global Grant.
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