Fewer antipsychotic medications being used in Hamilton nursing homes

After years of debate over powerful side effects, the use of antipsychotic medications to treat psychosis and dementia in Hamilton's long-term care homes has dropped, according to Health Quality Ontario.

It's an important topic these are elderly people with complex medical conditions.- Dr. JoshuaTepper, CEO of Health Quality Ontario

The Hamilton Niagara Haldimand and Brant LHIN once used antipsychotics at a higher rate than the rest of the province. Back in 2010, a third of long-term care home residents in the local LHIN were on the powerful drugs, compared to 32.1 per cent at the provincial level.

As of 2013 though, those numbers dropped both locally and provincially to 28.6 per cent at the local level and 28.8 percent provincially. The results are outlined in a new Health Quality Ontario report on antipsychotic use in Ontario.

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There are many reasons the drugs are being prescribed less, says Dr. Joshua Tepper, the CEO of Health Quality Ontario like a sensitivity to side effects and awareness of alternative treatment methods.

"It's an important topic these are elderly people with complex medical conditions," Tepper said.

The use of antipsychotic drugs comes with no shortage of controversy, as they are sometimes used on dementia patients as a form of chemical restraint. According to the report, almost 70 per cent of seniors using the medication in Ontario's long-term care homes had dementia, but not psychosis.

Eighteen per cent of people on antipsychotics had legitimate psychosis, while 12 per cent of people taking them had neither psychosis nor dementia.

Side effects of the drugs include sedation, higher risk of falling and a "slightly" increased risk of death, Tepper says. People who use them sometimes struggle to communicate and sleep for large parts of the day.

Benefits and side effects

But the drugs can also be helpful when used to treat behavioural issues and confusion in dementia patients.

"These medications have some real benefits in the right situations, but they also have side effects and risks," Tepper said.

Tepper's report also reveals that there is a startling range in how much these drugs are prescribed from home to home across the province. In some places, no residents are on antipsychotics while in others, a whopping 60 per cent of patients are on them.

Some of those differences can be explained by the fact that some homes care primarily for residents with psychosis, dementia and mental illness.

"Nevertheless, our findings suggest that there are opportunities for homes to examine and compare their antipsychotic medication use, and to re-evaluate prescribing decisions to help individual residents achieve the best possible quality of life," the report reads.