Antipsychotic drugs prescribed to seniors at alarming rates, province finds
A Health Ministry study commissioned after the Star began investigating the practice found nearly half of Ontario nursing home residents aged 65-79 are being given “dangerous” drugs.
Thousands of seniors in Ontario nursing homes are on a powerful mix of antipsychotics and sedatives, according to a new provincial Health Ministry report that surfaced aftera recent Star investigation.
The report, commissioned by the ministry and co-authored by a leading doctor and scientist, sheds new light on the widespread use of powerful prescription drugs among the vulnerable elderly.
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“These drugs are prescribed so commonly because they are perceived to be benign. That’s not true,” said Dr. David Juurlink, a drug safety expert who co-authored the report. “These drugs are inherently dangerous.”
Last week, the Star revealed that some long-term-care homes, often struggling with staffing shortages, are routinely doling out antipsychotics to calm and “restrain” wandering, agitated and sometimes aggressive patients.
At close to 300 homes, the Star found, more than a third of the residents are on the drugs, despite warnings that the medications can kill elderly patients who suffer from dementia. Provincial NDP Leader Andrea Horwath called the Star’s findings “horrifying.”
The new report, commissioned in early April, around the time the Star started asking the ministry questions about the issue, shows startling prescribing rates in certain age groups: nearly half (45 per cent) of all Ontario nursing home residents aged 65 to 79 are on an antipsychotic drug.
Health Minister Deb Matthews told the Star that her ministry asked for the report because appropriate prescribing in long-term-care homes is a priority. She said the government is working on an “education strategy … that can be rolled out across the province.”
The report also exposes the problem of high prescription rates of sedatives such as diazepam and lorazepam: 30 per cent of those aged 65-79 are on the drugs.
The report found the prescription rates “appear high,” and co-author Tara Gomes told the Star they “warrant further investigation” to find out why — “so that we can ensure we are not putting nursing home residents in harm’s way.”
To Juurlink, the common prescribing of antipsychotics, which can have a sedative effect, and of sedatives such as lorazepam suggests doctors are using the drugs to calm residents down.
“Sedation comes at a price — falls, bedsores, blood clots and direct adverse reactions to the drugs themselves, which can sometimes be fatal,” Juurlink said.
“Physicians who care for patients in long-term-care facilities should resist the urge to prescribe these drugs as freely as it seems they are. These drugs carry risks, and we have to afford (the patients) the respect they deserve.”
When the Star asked Ontario Health Minister Deb Matthews if she planned to advise doctors to prescribe the drugs more carefully, she said she is “committed to working with” doctors to improve care for nursing home residents.
In one case reported in the Star last week, an 85-year-old woman with dementia was on risperidone and other drugs to help control her wandering — an unapproved use — in a long-term-care home when she took a bad fall and died. (Risperidone, an antipsychotic, is approved to treat only dementia patients with severe psychosis or aggression.) The Ontario coroner’s office said the drugs that were inappropriately prescribed for her played a role.
The Health Ministry report also found that 10,220 seniors, or about 11 per cent of all seniors in long-term-care homes, are on both an antipsychotic and a sedative.
“You don’t have to think very hard to appreciate why that can be a dangerous thing to do,” Juurlink said.
Gomes added: “Both the antipsychotics and sedatives are flagged as drugs that are concerning with use in elderly populations because they can lead to harm. The fact that there are elderly people getting both of these products is particularly concerning to me.”
Fifteen per cent of all nursing home residents aged 65 to 79 are taking both an antipsychotic and a sedative at the same time.
The antipsychotic medications at issue, including olanzapine, quetiapine and at least 10 others, are not approved by Health Canada for elderly people with dementia. Pharmaceutical companies have issued the strongest possible caution, known as a black-box warning, on their labelling.
“Elderly patients with dementia treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo,” a typical warning says, adding that these patients face a 60-per-cent increased risk of death compared with similar patients who are not taking these drugs.
At one nursing home east of Ottawa, the Star found, 73 per cent of the residents are on the drugs.
In another of the cases probed by the Star, antipsychotic medication was apparently given to a senior without consent.
Ethel Geraldine Anderson, known as Aunt Gerry to her loved ones, is among such cases reported in the Star investigation. Anderson’s niece said “they tried to quiet her down” with doses of olanzapine in the Wellesley St. nursing home where Anderson was living. Four months later, she was dead.
The Health Ministry report showed that the older a nursing home resident is, the less likely she or he is to be put on an antipsychotic or sedative. Gomes said the data she analyzed does not say why, but she speculated that residents over age 85 may be frailer and less likely to act in an aggressive manner.
The data analyzed by Gomes and Juurlink does not say why the drugs were prescribed or what conditions the seniors were diagnosed with, though it is widely known among caregivers that more than 60 per cent of all Ontario nursing home residents suffer from dementia.
When antipsychotics are prescribed to seniors with dementia, it’s known as an “off-label” use, meaning a drug is being prescribed for a condition or age group for which it hasn’t been approved. It’s legal for doctors to do this, and they do so with little oversight.
In the case of sedatives, the product labelling associated with several of the drugs studied by Gomes and Juurlink say the drugs should be used with caution among the elderly.
“We all have loved ones in long-term-care homes, and we all want nothing but the best possible care for them,” Health Minister Matthews said. “I take very seriously my responsibility to ensure long-term-care residents get the care they deserve.”