Got a loved one in long-term care in Waterloo region? They could be on antipsychotics without a diagnosis

For years, many seniors living in long-term care homes across Waterloo Region have been receiving antipsychotic medication without a diagnosis of psychosis, according to a report from the Canadian Institute for Health Information (CIHI).

The findings show that between 2020 and 2021, an average of 19.4 per cent of seniors living in long-term care homes in Ontario received antipsychotics that they may have not needed. Antipsychotic medications may sometimes be prescribed without a diagnosis to treat people with dementia (to help manage outbursts or mood fluctuations) — but that off-label treatment is not recommended by Health Canada.

"A lot of it has to do with not enough nurses to look after persons with dementia to understand why they might be expressing certain behaviours," said George Heckman, a geriatrician and the Schlegel Research Chair of Geriatric Medicine at the University of Waterloo.

"Some of it has to do with the layout of the environment. It looks like an institution and not a home, and that older person with dementia might feel distressed or ill at ease or uncomfortable, and they're trying to get out or they're trying to get somebody's attention. And rather than have enough staffing and time to figure out what's driving this, antipsychotics are prescribed," he added.

Typically, antipsychotics are used to treat schizophrenia and other disorders with paranoia or delusions. But when used inappropriately, patients will experience a number of unwanted side effects.

"There's a chemical called dopamine, and they block dopamine and they can cause people to look like they have Parkinson's disease," Heckman said.

"They can slow down your muscle function, they can cause swallowing problems. Some of them are sedating, some of them can cause falls. And there's also an increased risk of cardiovascular disease, stroke and heart attacks in people who take them for four to six weeks or more, so they're not benign medications," he added.

CIHI found that 22 per cent of long-term care residents in Canada are being 'potentially inappropriately' prescribed antipsychotic drugs. It is classified as 'potentially inappropriate' because the patients have no diagnosis of psychosis.

Most of the homes in the Waterloo Wellington area are either right at the provincial rate of 19.4 per cent — or lower.

But there were also some exceptions. The rate at Golden Years Long-Term Care in Cambridge was at its highest in 2020 at 41.8 per cent. That's more than double the provincial average. It was also the highest rate in all of the Waterloo Wellington area by the end of 2020.

Jenn Killing, clinical lead and vice president of peopleCare Homes, which is the parent company of Golden Years Long-Term Care, said context is key when it comes to understanding the findings.

"A high admission frequency does play a really dramatic role. Very, very high percentage of residents when admitted to long-term care from either community or hospital, are on antipsychotics without a diagnosis," she said.

"According to our current data, the average range across our three homes in the Waterloo region is 24.2 per cent... Golden Years, specifically, is currently at 22.2 per cent," she added.

She said they improved their rate by implementing a program where medical staff review the effectiveness of medications like antipsychotics.