Care homes overmedicating seniors, study shows: Gerrard

Liberal Leader Jon Gerrard wants the province to investigate "excessive" use of potentially harmful antipsychotic drugs in personal-care homes after a new study revealed their use has skyrocketed in the last decade.

A Manitoba Centre for Health Policy study released Friday examined four categories of drugs that have become more expensive or more prescribed over time, including asthma inhalers, medications and test strips for diabetes, antipsychotics among the elderly, and drugs for inflammatory conditions such as arthritis. While researchers found most prescriptions follow the recommended guidelines, they raised concerns about the rise in antipsychotic drugs prescribed for older patients.

Medication guidelines advise doctors not to prescribe second-generation antipsychotics to older patients with dementia due to an increased risk of stroke and falls, but the study found the number of patients in personal-care homes on the drugs rose from 15 per 1,000 in 1997 to 268 people per 1,000 in early 2009.

Gerrard said Health Canada has issued multiple warnings about these drugs, yet 27 per cent of all personal-care home residents are now on this medication -- up from just two per cent 10 years ago. He said Health Minister Theresa Oswald should launch an immediate investigation to find out which personal-care homes are prescribing these drugs and set better standards of care for the elderly.

"This level of use is very, very troublesome," Gerrard said.

A provincial spokesman said in an email that the trend is concerning and the government will continue to look into the issue. He said the government is working to improve prescribing practices, including hiring nurse practitioners to work in personal-care homes.

Two Winnipeg personal-care homes that hired nurse practitioners had a significant decrease in the use of antipsychotic drugs, the spokesman said. The percentage of residents on the drugs dropped from 15 to seven per cent since 2007 at Lions Personal Care Centre, and 33 to 12 per cent at Kildonan Personal Care Centre since 2008.

Gerrard said there's no medically "credible" reason why personal-care homes are prescribing the drugs more often than they used to. "They have been demonstrated to cause harm in seniors."

He said antipsychotics could be used as a form of "restraint" or "behavioural control" on elderly patients.

Manitoba has rigorous standards regarding the use of drugs to restrain patients, the government statement said, and health-care providers are to use the least amount possible to ensure patient safety and independence.

Researchers did not examine whether the prescriptions harmed any Manitoba patients.

Colette Raymond, a Winnipeg pharmacist and the study's lead researcher, said the drugs have side-effects such as tremors and spasms that can lead to falls, broken bones and other complications.

She said the good news is that only 10 per cent of new patients put on antipsychotics received a high dose.

The study also found a decline in the number of correctly prescribed asthma inhalers.

Asthma patients are not supposed to take a long-acting beta agonist (inhaler) without also taking a steroid, due to the risk of serious side-effects, including hospitalization and death. The study found only 29 per cent of Manitoba adults with asthma were prescribed a steroid before they received a prescription for a long-acting beta agonist in 2008, down from close to 50 per cent in 2002. In children, the proportion prescribed a steroid before a physician prescribed a long-acting beta agonist dropped from 54 to 37 per cent from 2002 to 2008.

jen.skerritt@freepress.mb.ca

What are antipsychotics?

A class of medications used to treat a variety of psychiatric conditions. It includes new or second-generation antipsychotics, such as risperidone, olanzapine and quetiapine.

Are they risky for patients with dementia?

Several Health Canada warnings have advised that the drugs can cause serious side-effects for patients with dementia, including an increased risk of falls, movement disorders, decreased blood pressure and death. The lowest possible effective dose is recommended for people with dementia.

What did the study find?

That the use of antipsychotics among residents in personal-care homes has increased significantly -- 27 per cent of all residents were on the drugs in early 2009, compared to just two per cent of residents in 1997. The number of patients in personal-care homes on the drugs rose from 15 per 1,000 in 1997 to 268 per 1,000 in early 2009.

--Source: Manitoba Centre for Health Policy

Republished from the Winnipeg Free Press print edition January 21, 2011 A7