Nearly 25% of nursing home residents prescribed antipsychotic drugs within one year of admission

Nearly one quarter of Ontario nursing home residents are prescribed neuroleptic (antipsychotic) drugs within the first year after their admission, a new study from the Institute for Clinical Evaluative Sciences (ICES) looking at the use of these medications in the nursing home setting has found.

Neuroleptics are well-accepted drug therapies to manage people with major psychological conditions, such as schizophrenia. However, concerns have been raised about their use in older adults with dementia in nursing homes because of the potential for serious adverse events, such as drug-induced Parkinsonism, falls, and cerebrovascular events.

For this study, researchers examined nearly 20,000 elderly Ontarians who had never been prescribed neuroleptics and were new residents of a nursing home between 1998 and 2000. They tracked the number of residents started on neuroleptic drugs, the dosage they were given, and if they saw a geriatrician or psychiatrist (specialists with expertise in treating dementia).

Results:

• Neuroleptics were newly prescribed for 17% of the residents within 100 days of being admitted to a nursing home, and to 24% within 1 year of their nursing home admission.
• Almost 10% of nursing home residents who were prescribed neuroleptics received an initial dose that exceeded recommended thresholds.
• Only 14% of nursing home residents started on neuroleptics had contact with a geriatrician or psychiatrist prior to their prescription.

“The high initial doses of neuroleptics being given to patients and the limited contact with specialists raises some important questions about the quality of clinical practice surrounding this sort of therapy in Ontario nursing homes,” said lead author and ICES scientist Dr. Susan Bronskill.

"Prescribing patterns have changed dramatically over time, in part due to the availability of newer neuroleptics. We need to review how these therapies are being used in institutions." “There are several strategies that can improve the prescribing patterns of these drugs,” said Dr. Paula Rochon, senior author, ICES scientist, and senior scientist at the Kunin-Lunenfeld Applied Research Unit at the Baycrest Centre for Geriatric Care. “Non-pharmacological approaches must always be considered as the initial therapy and specialists should be involved as much as possible. If neuroleptics are used, patients should always be started on the lowest possible dose.”

The study, “Neuroleptic drug therapy in older adults newly admitted to nursing homes: incidence, dose, and specialist contact”, is in the May 4, 2004 issue of the Journal of the American Geriatrics Society.

This study was supported by the Canadian Institutes of Health Research (CIHR) Chronic Disease New Emerging Team (NET) program. The NET program receives joint sponsorship from the Canadian Diabetes Association, the Kidney Foundation of Canada, the Heart and Stroke Foundation of Canada, and the CIHR Institutes of Nutrition, Metabolism & Diabetes and Circulatory & Respiratory Health.

Author affiliations: Dr. Susan Bronskill, Dr. Geoffrey Anderson, Ms. Kathy Sykora, Dr. Walter Wodchis, Dr. Paula Rochon – ICES; Dr. Susan Bronskill, Dr. Geoffrey Anderson, Dr. Paula Rochon – Department of Health Policy, Management and Evaluation, University of Toronto; Dr. Walter Wodchis – Toronto Rehabilitation Institute; Dr. Sudeep Gill, Dr. Paula Rochon – Kunin-Lunenfeld Applied Research Unit, Baycrest Center for Geriatric Care; Dr. Kenneth Shulman – Department of Psychiatry, Sunnybrook and Women’s College Health Sciences Center.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Julie Argles
• Media Relations Officer, ICES
• (416) 480-4055 ext. 3602 or cell (416) 432-8143