Are Antipsychotic Drugs Being Overprescribed to Elderly Patients?

Antipsychotic medications are primarily used to help people with severe mental illness control symptoms of psychosis such as hallucinations, delusions, or disordered thinking.   So, why are these medications being increasingly prescribed to elderly patients?  According to Tev Patel, a clinical pharmacist with the Centre for Family Medicine in Kitchener, and an assistant professor at the University of Waterloo, many antipsychotics are being prescribed to elderly patients when they are clearly not needed, even when serious side effects could potentially put the lives of these patients at risk.   

"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 in an interview with CBC News.   "in some patients, they're quite effective, and in others, they're not effective at all," she added.  Even in cases where patients are openly violent or psychotic, she argues that anti-psychotic medication should only be used as a short-term solutions rather than as a long-term method for keeping patients calm. 

But a new University of Waterloo study suggests that anti-psychotics are being overused with dementia patients, often with little real justification.  Lead researcher Chris Perlman, an assistant professor at the University of Waterloo's School of Public Health and Health Systems, has been looking at data from across Canada with patients in acute care hospitals, nursing homes and complex continuing care facilities, and even home care.   Among the study's findings are that:

  • Fourteen percent of patients in home care have been prescribed anti-psychotic medications
  • Twenty-seven percent of acute care hospital patients on waiting list for nursing home beds have been prescribed anti-psychotic medication
  • 35 percent of patients in long-term care facilities have also been prescribed anti-psychotic medication.

In many cases, the medication is prescribed to elderly patients even if they aren't showing "behavioural or psychological symptoms."  While anti-psychotic medication is typically used for patients suffering from schizophrenia or other severe mental health disorders,  their sedative effects make them useful in tranquilizing patients and make it easier to care for them.  Such "off-label" use for psychiatric medication is hardly uncommon and dementia patients in other provinces are also frequently over-medicated as well.  Among the adverse side effects linked to many anti-psychotic medications are: 

  • Headaches
  • Weight gain
  • Extrapyramidal symptoms including tremors, restless legs, and movement problems often seen in patients with Parkinson's disease
  • Anticholinergic side effects such as blurred vision, constipation, constipation, and dry mouth.
  • Less common symptoms can include tardive dyskinesia, a frequently irreversible neurological syndrome with repetitive movements of the face, legs, or torso.

Since elderly patients often have other medical conditions for which they are being treated, the possibility of adverse drug interactions also remains high and doctors need to be vigilant in monitoring their medication.   Given the potential dangers involved with using anti-psychotic medication on these patients, Christ Perlman says that is is "alarming" to see what is happening across Ontario.   

While advocacy groups such as the Ontario Long Term Care Association note that fewer long term care homes are using anti-psychotic medication to treat elderly residents,  these facilities still need to provide more behavioural support programs to avoid the need for overmedicating patients.   As the number of dementia patients continues to rise worldwide,  relying on medication to make them more manageable may become a much bigger problem in the years to come.

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