Summary: A study of 500,000 Canadian nursing home residents found antipsychotic medications significantly worsened behaviors in patients, with nearly 68% experiencing increased issues. Antipsychotics are often prescribed “off-label” for dementia-related symptoms, despite serious side effects like tremors and cognitive decline.
Researchers advocate for person-centered care, emphasizing non-drug therapies like music, art, and exercise to address behavioral issues. Training staff to reduce reliance on antipsychotics could improve resident outcomes, fostering less agitation and better quality of life. The findings call for a reevaluation of antipsychotic use in non-psychotic conditions.
Key Facts:
- Behavioral Decline: 68% of residents on antipsychotics showed worsened behavior.
- Off-Label Use: 26% of nursing home residents received antipsychotics for unapproved purposes.
- Non-Drug Therapies: Alternatives like music, exercise, and pain management improve outcomes without medication.
Source: University of Waterloo
A new study conducted by researchers at the University of Waterloo analyzed data from nearly 500,000 Canadian patients who lived in nursing homes across Canada between 2000 and 2022.
It found that residents who were given antipsychotic medications showed a significant worsening of their behaviours. In fact, nearly 68 per cent of residents who used antipsychotics had more problems with their behaviour during follow-up checks.
“This is the first national longitudinal study of its kind, using a statistical technique to measure the effect of antipsychotic treatments,” said Dr. Daniel Leme, the study’s lead author and a postdoctoral scholar in Waterloo’s School of Public Health Sciences.
Antipsychotics are often prescribed in nursing homes “off-label,” meaning they’re used for purposes not approved by health authorities like the U.S. Food and Drug Administration (FDA). For example, they might be given to manage behaviours associated with dementia, even though these drugs are only approved for treating conditions like schizophrenia or certain types of psychosis.
The study found that 26 per cent of nursing home residents in Canada were given antipsychotics in ways not recommended by the FDA between 2014 and 2020.
Although antipsychotics are often used to calm residents with aggressive or agitated behaviour, the medications can have serious side effects. These include tremors, restlessness, rigidity, painful muscle contractions and the inability to stand and walk, which can exacerbate existing behavioural and psychological symptoms.
“Sometimes people may say they don’t have enough staff to deal with these issues, but the reality is that these medications can make disability and cognitive impairment worse,” said Dr. John Hirdes, a professor in the School of Public Health Sciences.
“We need to seriously reconsider the use of antipsychotics for people who do not have conditions associated with psychosis.”
The study outlines the inappropriate use of antipsychotics to treat behavioural and psychological symptoms of dementia (BPSD), which can include irritability, aggression, agitation, anxiety, depression, sleep or appetite changes, apathy, wandering, repetitive questioning, sexually inappropriate behaviours and refusal of care.
Instead of turning to medication right away, researchers suggest focusing on person-centred care — getting to the root causes of a resident’s behaviour and offering support in other ways.
For example, a resident might need better pain management, clearer communication, or activities to help reduce anxiety. Non-drug therapies like music, art, social interaction, and gentle exercise have been shown to help manage behaviour without the need for antipsychotics.
Training staff to understand the risks of antipsychotics and how to offer better care has also been linked to improved outcomes for nursing home residents, including less agitation and a better quality of life.
The study, published in the November 2024 issue of the Journal of the American Medical Directors Association, is part of an international project called I-Care4Old, and was funded by the New Frontiers Research Fund Global Grant.
About this psychopharmacology research news
Author: Ryon Jones
Source: University of Waterloo
Contact: Ryon Jones – University of Waterloo
Image: The image is credited to Neuroscience News
Original Research: Open access.
“A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care” by Daniel Leme et al. Journal of the American Medical Directors Association
Abstract
A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care
Objective
The proportion of long-term care (LTC) residents being treated with antipsychotic medication is high, and these medications may exacerbate behavioral symptoms. We used propensity scores to investigate the effect of antipsychotic use on the worsening of behavioral symptoms among residents in LTC facilities.
Design
A retrospective study.
Setting and participants
Residents in LTC in 8 provinces and 1 territory in Canada, without severe aggressive behavior at baseline and reassessed at follow-up, between March 2000 and March 2022.
Methods
We used propensity score matching and weighting to balance baseline covariates and logistic regression to estimate the effect of antipsychotics on the worsening of behavioral symptoms in the original, matched, and weighted cohorts. The treatment variable was use of antipsychotic medication at baseline and the outcome was worsening of behavior at follow-up.
Results
A total of 494,215 participants were included [318,234 women and 175,981 men; mean age 82.8 years (SD 10.1; range 18–112)].130 558 (26.4%) used antipsychotics at baseline and 88,632 (17.9%) had worsening behavior in follow-up. In the matched cohort, there were 249,698 participants, and 124,849 were matched (1:1) in each treatment group.
There was a significant association between antipsychotic use at baseline and worsening in behavior at follow-up in the adjusted regression models [OR 1.27 (95% CI 1.25–1.29), <0.0001] as well as in matched [OR 1.20 (95% CI 1.17–1.21), <0.0001] and weighted [OR 1.26 (95% CI 1.24–1.28), <0.0001] cohorts.
Conclusions and implications
This study further evidence to support the cautious use of antipsychotics in LTC facilities. Future research in LTC facilities could include a more granular analyses of behavior change, including bidirectional analyses between different symptom severity classifications.
