Alternatives to antipsychotic drugs for seniors in nursing homes

Originally appeared on CanadianHealthcareNetwork.ca

If your clients or their parents live in long-term care facilities, they should be aware of efforts to find alternatives to antipsychotic drug treatments.

A new report, Use of Antipsychotics Among Seniors Living in Long-Term Care Facilities, 2014, showed that 39% of residents in long-term care facilities were prescribed an antipsychotic at least once in 2014 to treat symptoms of dementia, such as aggression and agitation (including cases where use may be appropriate).

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But there was a positive trend: Antipsychotic use was highest among residents with severe cognitive impairment and those exhibiting very aggressive behaviour. However, the rate of use among seniors exhibiting highly aggressive behaviours (51.3%) suggests that even in the most severe cases, where residents or caregivers may be at risk of harm, non-drug treatment options are being considered.

“There are a number of initiatives across the country that have been successful in decreasing the use of antipsychotics in (long-term care),” said Jordan Hunt, manager of pharmaceuticals at CIHI, in an interview. “It is encouraging that even up to 2014, there are signs that initiatives are working. Hopefully, as we look at 2015 and 2016, that becomes even more widespread and the decreases continue.”

The Canadian Foundation for Healthcare Improvement (CFHI) is working with facilities across Canada, and has helped more than 50 long-term care facilities implement alternatives to antipsychotics for residents with dementia. For example, between 2010 and 2014, the use of antipsychotics in long-term care facilities in Manitoba fell from about 38% to 31.5%. During this time, the Winnipeg Regional Health Authority participated in CFHI’s Executive Training for Research Application Program, which encouraged front-line staff to work together to implement creative solutions to manage dementia behaviours, with medication to be used only as a last resort.

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The Middlechurch Home of Winnipeg used the PIECES program (Physical, Intellectual, Emotional, Capabilities, Environment and Social), and health-care providers were trained to assess those dimensions in patients. This made them better equipped to manage the challenging behaviours of patients with dementia using creative solutions. Before participating, the rate of antipsychotic use at the facility was 40%, and the drugs were often used as a first line of treatment. In six months, the rate of use dropped by more than 25% in residents who were on the drugs when the program began. And even though using the drugs became a last resort, aggressive behaviours did not increase and costs also decreased.

Hunt said physicians, and the whole team of long-term-care health providers, should keep in mind the need to consider alternatives to antipsychotics. Individualized interventions can include strategies such as a change in environment, change to meal times, increasing social interaction, listening to music or going for walks.

“If there is still a risk of harm and you need to prescribe drugs, the use of drugs should be evaluated on an ongoing basis,” Hunt said. “You should revisit regularly to see if there is an opportunity to reduce the dose or try other options.”

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