Don’t overuse powerful drugs
If ever there was a case study to prove the point that nursing-home doctors should carefully assess, and reassess, the prescribing of antipsychotic drugs, the story of “Mary,” as described in a new report from Health Quality Ontario, is it.
Mary was prescribed an antipsychotic medication after experiencing outbursts of screaming. More than two years later, she was still on the medication, although the powerful drug caused her to spend many of her days in a deep sleep. When she was awake she did not talk — at all.
Unlike many nursing home patients in Ontario, Mary was lucky. Medical staff reassessed her condition and decided to reduce and eventually stop her antipsychotic medication. She perked up immediately. One day she looked at one of her daughters and said, “I love you.” It was the first time in years her daughters had heard her speak.
Mary’s case is just one described in the welcome report from the arm’s-length government agency that monitors the performance of the province’s health system. Its release this week draws muchneeded attention to the use — and overuse — of antipsychotic drugs in nursing homes.
As the report points out, antipsychotics can be an effective treatment for patients with severe aggression, agitation or hallucinations. But they also increase the risk of falls, stroke, pneumonia and, among the elderly with dementia, death.
That’s why over-prescribing them is so dangerous — and, in cases like Mary’s, so sad.
And there’s no question the drugs are over-prescribed. For example, the study found more than 60 per cent of residents at some nursing homes are on antipsychotics, while at other homes no patients are. A high rate at some homes could be explained by the fact that they care for a large number of mental health patients. Still, Dr. Joshua Tepper, chief executive of Health Quality Ontario, acknowledged that reason alone could not explain the wide variation among homes.
On a more positive note, the report found a slight drop in the number of patients prescribed antipsychotics. From 2010 to 2013 it dropped from 32 per cent of long-term care residents to nearly 29 per cent.
Still, a case at Etobicoke’s Village of Humber Heights, described in the 21-page report, shows that when the focus is on assessing individual needs, the prescription rate can drop dramatically further.
At Humber Heights, staff put a “laser focus” on the issue, cutting the prescription rate almost in half from 32 per cent of residents to 17 per cent. “What was so surprising was there were so few cases where there was any worsening behaviour,” the director of care, Caroline Shemilt, told the Star.
While the report focuses general attention on the over-prescribing of antipsychotics, Health Quality Ontario promises to go still further. In the coming months it plans to release information on individual homes and share prescribing data with doctors so they can evaluate their own practices.
All this new openness is good news for Ontario’s most vulnerable patients. And as a Star investigation by reporters Jesse McLean and David Bruser found last year, it’s also long overdue. The report should be required reading for medical staff in all nursing homes.
New report draws attention to the use — and overuse — of antipsychotic medication in Ontario nursing homes