A new study conducted by researchers at the University of Waterloo analyzed data from nearly 500,000 Canadian patients living in nursing homes across Canada between 2000 and 2022. This showed that residents receiving antipsychotic medications showed a significant deterioration in their behavior. In fact, almost 68 percent of residents taking antipsychotics had more problems with their behavior during follow-up checks.
This is the first national longitudinal study of its kind using a statistical technique to measure the effect of antipsychotic treatments.”
Dr. Daniel Leme, lead author of the study and postdoctoral researcher at Waterloo’s School of Public Health Sciences
Antipsychotics are often prescribed “off-label” in nursing homes, meaning they are used for purposes not approved by health authorities such as the U.S. Food and Drug Administration (FDA). For example, they may be given to control behavior associated with dementia, even though these medications are only approved for treating conditions such as schizophrenia or certain types of psychosis. The study found that between 2014 and 2020, 26 percent of nursing home residents in Canada were administered antipsychotic medications in a manner not recommended by the FDA.
Although antipsychotics are often used to calm residents with aggressive or irritable behavior, the medications can have serious side effects. These include tremors, restlessness, stiffness, painful muscle contractions, and the inability to stand and walk, which can worsen existing behavioral and psychological symptoms.
“Sometimes people may say they don’t have enough staff to address these issues, but the reality is that these medications can worsen disability and cognitive impairment,” said Dr. John Hirdes, professor in the School of Public Health Sciences. “We need to seriously reconsider the use of antipsychotics for people who do not have conditions associated with psychosis.”
The study outlines the inappropriate use of antipsychotics for the treatment of behavioral and psychological symptoms of dementia (BPSD), including irritability, aggression, agitation, anxiety, depression, changes in sleep or appetite, apathy, wandering, repetitive questioning, sexually inappropriate behavior and refusal. of care.
Rather than turning immediately to medication, researchers suggest focusing on person-centered care; discovering the root causes of a resident’s behavior and offering support in other ways. For example, a resident may need better pain management, clearer communication, or activities to help reduce anxiety. Non-drug therapies such as music, art, social interaction, and gentle exercise have been shown to help control behavior without the need for antipsychotic medications.
Training staff to understand the risks of antipsychotic medications and how to provide better care has also been linked to better outcomes for nursing home residents, including less anxiety and better quality of life.
The study, published in the November 2024 issue Journal of the American Medical Directors Associationis part of an international project called I-Care4Old, and was funded by the New Frontiers Research Fund Global Grant.
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Magazine reference:
Leme, DEC, et al. (2024). A longitudinal analysis of the treatment effect of antipsychotics on the behavior of long-term care residents. Journal of the American Medical Directors Association. doi.org/10.1016/j.jamda.2024.105255.