Use of antipsychotics, antidepressants far higher in long-term care than outside
A new study examining drug use among Canadian seniors on public drug programs offers a startling look at the number of drugs seniors are taking, some of them potentially harmful.
The report, released Thursday by the non-profit Canadian Institute of Health Information (CIHI), uses 2012 data from the public drug programs of eight provinces and one federal program managed by the First Nations and Inuit Health Branch.
It shows that people 65 and over represent only 15 per cent of the population yet account for nearly two-thirds of public drug program spending — a percentage that will likely increase when the so-called “grey tsunami” of aging baby boomers rushes in.
Unfortunately, Newfoundland and Labrador did not contribute data to the study, so there are no specifics for this province. As for why we didn’t participate, the Department of Health hadn’t answered that question as of this writing.
However, it’s fair to extrapolate from the report that seniors on public drug programs rely on many medications, often to treat chronic conditions, and seniors in long-term care use far more drugs than seniors living in the community.
What’s most disturbing is the use of potentially harmful drugs — antipsychotics — among seniors in long-term care.
“Antipsychotics, such as quetiapine and risperidone,” the report states, “are also commonly used to treat the behavioural and psychological symptoms of dementia, including delusion, aggression and agitation. Manufacturer and regulatory warnings have been released about the risk of antipsychotic use in elderly patients who have dementia. Studies have shown that the use of psychotropic drugs is related to an increased number of falls among seniors and that the use of antipsychotics in elderly patients with dementia may be associated with a small increase in the risk of death.”
And yet, 40.7 per cent of seniors on public drug programs in long-term care are on anti-psychotic drugs as compared to only 4.4 per cent of seniors in the community at large.
“The increased risks associated with psychotropic drugs are of particular concern in (long-term care) facilities due to their higher rate of use,” the report states.
As well, due to the much higher incidence of depression among long-term care residents, 30.8 per cent of seniors in facilities were taking benzodiazepines — tranquilizers — compared to 15.1 per cent of seniors in the community; and 58.2 per cent were being prescribed anti-depressants compared to 18.8 per cent in the community.
Those differences are startling, and say much about the benefits of seniors living independently for as long as they can.
Almost two-thirds of seniors in nursing homes had claims for 10 or more classes of drugs in 2012, more than double the amount prescribed to seniors in the community.
Jordan Hunt, the CIHI’s manager of pharmaceuticals and health work force information, says that’s not surprising.
“Seniors in long-term care often have more conditions, and conditions that have progressed to a more advanced stage than seniors living in the community,” he wrote to The Telegram via email. “It is often because of the progression of conditions like dementia that they require long-term care. These things can also contribute to seniors in long-term care taking a higher number of drugs.”
There’s a list of drugs that are “potentially inappropriate” for seniors, called the Beers list — named for Dr. Mark H. Beers, the American geriatrician who developed the list in 1991.
“These drugs are identified as potentially inappropriate to prescribe to seniors due to an elevated risk of adverse effects, a lack of efficacy in seniors or the availability of safer alternatives,” the CIHI report notes.
And yet, nearly one-quarter of seniors on public drug programs in 2012 were on at least one drug from the Beers list, and 5.2 per cent were on two or more.
It raises a disturbing question: why are physicians prescribing drugs for seniors that could potentially harm them?
The most commonly prescribed drug on the Beers list is lorazepam, often dispensed under the brand name Ativan, a highly addictive anti-anxiety medication which the U.S. Coalition Against Drug Abuse notes can cause elderly patients to suffer “a worsening in the cognitive deterioration caused by aging or with existing dementia.”
Benzodiazepines such as Ativan have also been linked to “increased behavioral problems and impairment in both memory and psychomotor skills,” according to the University of California, San Francisco’s Memory and Aging Center.
The CIHI report notes, “lorazepam is listed as potentially inappropriate because there is a greater risk of cognitive impairment, delirium, falls, fractures and motor vehicle accidents.”
The bottom line is that many seniors are taking medications that carry a high price, both in terms of their own health and the public drug program.
If you are a senior or have aging parents, it’s extremely important to regularly review medications to see if they are still — or were ever — necessary.
And if your loved one has dementia and is being prescribed antipsychotic drugs that could actually accelerate the progression of their condition, you have every right to challenge whether that is the best solution.
As the Alzheimer’s Society in the U.K. notes on its website, “People with dementia have frequently been prescribed antipsychotic drugs as a first resort, and it has been estimated that around two-thirds of these prescriptions are inappropriate.”
Pam Frampton is a columnist and The Telegram’s associate managing editor.