Reduce overuse of antipsychotics in nursing homes: geriatrician

Hundreds of people in Ontario nursing homes are on antipsychotic drugs they may not need, a new study suggests.

Seniors taking the medications may lose their balance, appear sedated or shake like someone with Parkinson's disease.

The latest type of antipsychotic drugs, called atypicals, were designed to treat schizophrenia and other major psychiatric illnesses.

"What worries me is if the drugs are being used because someone's having trouble sleeping or the drugs are being used because they're wandering,"said Dr. Paula Rochon, ageriatrician with Baycrest Geriatric Health Care System in Toronto,the study's senior author, and a senior scientist at the Institute for Clinical Evaluative Sciences.

"Now that's inappropriate. [There are] lots of other things that can be done."

Alternatives to medication include allowing residents to sleep ininstead of enforcing a9 a.m. wake-up, since peopleare less aggressive when rested, said Penney Minor, a clinical nurse manager at Baycrest.

In nursing homes, atypicals should generally be reserved to manage psychoses and whenbehavioural problems pose a risk to residents themselves or others, Rochon said, given that serious side-effects of the drugs include risk of falls and hip fractures.

Over-prescribing concerns

For the study in this week's issue of the Archives of Internal Medicine, Rochon and colleagues at tracked more than 47,000 nursing home residents in nearly 500 institutions in the province in December 2003.

A total of 15,317 32 per cent were dispensed an antipsychotic. In some homes almost half the residents were on the drugs.

More than 800 patients who had no prior indication of either dementia or psychosis were on the drugs, the researchers found.

Residents living in facilities with high antipsychotic prescribing rates were about three times more likely than those in facilities with low prescribing rates to be dispensed an antipsychotic agent, regardless of the clinical indication for the drug, the researchers concluded.

Over-prescribing is one of the main concerns for family members of people living in nursing homes.

Many relatives complained that they only found out a loved one in a nursing home was on an antipsychotic after the fact, said Jane Meadus, a lawyer with the Advocacy Centre for the Elderly.Nursing home staff may see the drugs as a quick fix.

"They don't have the time or the resources necessary to sort of look into the issue and see why the person is acting up," said Meadus. "They just want to sort of go to the anti-psychotic as being the easy answer."

Familiesneed toknow that if a senior cannot give consent, relatives are the ones who have to OK the use of any medication.

A bill before the Ontario legislature aims to ensure that people living in long-termcare are not subjected to too many drugs, including antipsychotics, Health Minister George Smitherman said.