Ontario’s nursing homes should examine their use of powerful antipsychotic drugs on vulnerable patients, suggests a new report that shows a striking discrepancy in prescribing rates at long-term care homes across the province.
At some nursing homes, more than 60 per cent of residents are prescribed antipsychotic medications, while other homes are prescribing none, according to a report released Wednesday by Health Quality Ontario, which monitors the performance of the province’s health system.
The stark findings present an opportunity for nursing homes to “re-evaluate prescribing decisions to help individual residents achieve the best possible quality of life,” the report said.
The drugs can sedate and appear to increase the risk of falls, stroke, pneumonia and, among the elderly with dementia, death, the report said.
Despite the risks, antipsychotic medications can be an effective treatment for patients who have severe aggression, agitation or hallucinations caused by dementia — symptoms that make the resident a danger to himself and others.
“It is very much a call to action to reflect and make sure we’re using best practices for each individual patient. These are very vulnerable patients and these are complex patients,” said Dr. Joshua Tepper, chief executive of Health Quality Ontario, an arm’s-length government agency.
He stressed that there is not a target percentage of residents on antipsychotics for which nursing homes should aim, adding that each home must consider the needs of individual patients.
“Some of the variation (across nursing homes) probably reflects that certain homes have a mix of clients, some with very high numbers of mental health patients. But I don’t think that alone would explain this range of variation,” Tepper said.
The report follows a 2014 Toronto Star investigation that showed nursing homes were drugging helpless seniors at an alarming rate despite warnings on the antipsychotic labels that they carry an increased risk of death for elderly patients suffering from dementia.
The Star found that some long-term care homes, often struggling with staff shortages, were routinely doling out these risky drugs to calm and “restrain” wandering, agitated and at times aggressive patients.
The Star then launched a publicly accessible online database that allows families of seniors to see antipsychotic drug use rates in individual Ontario homes. The database, created using previously unreleased government data from six months in 2013, provided an unprecedented snapshot of the issue.
In coming months Health Quality Ontario will be releasing information on individual homes.
As part of a joint initiative, the agency will also share prescribing data with individual doctors so they can evaluate their own practices, Tepper said.
The agency’s report found the overall antipsychotic prescribing rate in Ontario nursing homes has declined slightly from 2010 to 2013. Still, nearly 29 per cent of long-term care home residents are prescribed the drugs.
The report also included anecdotes from nursing homes where staff and management dedicated resources to assessing their prescribing and reviewing the behaviour of individual residents to see if non-drug therapies might work.
Beginning in early 2014, staff at Etobicoke’s Village of Humber Heights with a “laser focus” on the issue cut its prescription rate from 32 to 17 per cent of residents.
Director of care Caroline Shemilt told the Star that residents became more alert and showed more participation in recreation activities.
“What was so surprising was there were so few cases where there was any worsening behaviour,” Shemilt said. “To improve somebody’s quality of life, to be able to help do that, words can’t describe it.”
As the Health Quality Ontario report points out, staffing levels, staff resources and training can affect antipsychotic use.
The Star’s 2014 investigation included comments from the head of several nursing homes who said a nurse shortage contributed to an overreliance on drugs to handle elderly patients with dementia.