Anti-psychosis drugs prescribed at 'alarming' rates, UW professor says

A Kitchener-area pharmacist is sounding alarm bells over a University of Waterloo study that appears to show the prevalent and unnecessary use of anti-psychosis drugs in older adults with dementia. 

Tejal Patel, a clinical pharmacist with the Centre for Family Medicine in Kitchener, and an assistant professor at the University of Waterloo, told CBC News potentially-fatal drugs are being administered in situations where they are not needed. 

"The use appears to be quite prevalent in terms of anti-psychotics in patients who have dementia and are above 65 years of age," she said.

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Chris Perlman, an assistant professor at the University of Waterloo's School of Public Health and Health Systems, has been working on the study using data from select provinces, including Ontario. It looked at people over the age of 65 with symptoms associated with behavioural and psychological symptoms of dementia (BPSD). 

Perlman explained information was collected from home care, acute care hospitals, nursing homes and complex continuing care facilities "to determine how these anti-psychotic medications are being prescribed" in relation to patient needs. 

"What we discovered was that the rates of prescribing of anti-psychotics were quite high amongst these different health sectors — particularly amongst individuals who had no symptoms of behaviours or other psychological symptoms," Perlman said.

"It appears that use is quite prevalent across all areas of residents. Whether it's in the home, whether it's in long-term care, whether it's in acute care — especially among patients with dementia," Patel said.

Perlman said figures from the study showed that in people over 65 with dementia:

• 14 per cent of patients in home care had been prescribed anti-psychotic medications. 
• 27 per cent of Ontarians waiting for nursing home beds at acute care hospitals had been prescribed anti-psychotic medications.
• 30 per cent in complex continuing care hospitals had been prescribed anti-psychotic medications.
• And 35 per cent of those in long-term care facilities had been prescribed anti-psychotic medications.

Despite exhibiting "no behavioural or psychological symptoms."

There is an underlying risk of increased risk of death in patients who are older and have dementia that has been established.- Tejal Patel, clinical pharmacist

Anti-psychosis drugs can be effective in treating agitation or aggressive behaviours, acknowledges Patel, by controlling the neurochemistry in the brain to decrease the symptoms of hallucinations and delusions. 

"And in some patients, they're quite effective, and in others, they're not effective at all," she said, adding she would like to see such medications only used in worst-case scenarios to treat symptoms of psychosis and aggression.

"And even then, I hope that we're using it for [the] short term. Just for a brief period of time and then tapering it. What the study tells me, though, is maybe that's not what's occurring," Patel said.

'Not a recommended practice'

The pharmacist acknowledged these drugs are less helpful in addressing wandering behaviours, insomnia, verbal aggression, depression, social withdrawal and pacing. 

"Anti-psychotic medications are not recommended as a first line of intervention" in treating those with symptoms, Perlman said. "It is alarming to see such rates for individuals with no symptoms ... this is not a recommended practice."

A structured social program might be a better way forward in dealing with dementia patients because it helps engage the patient and may even prevent the onset of symptoms that would require these anti-psychosis medications, Perlman noted. 

The Ontario Long Term Care Association in Kitchener says it wants to see more behavioural support programs in long-term care homes to better manage dementia patients, and health care professionals say they say this is a good step towards reducing the amount of drugs prescribed that ultimately have the power to do more harm than good.