Parkinson’s patients are often over-prescribed: study
WATERLOO — Nursing home residents with Parkinson’s disease are frequently given potentially harmful antipsychotic drugs without clear justification, according to a new report.
The study by the University of Waterloo and the Schlegel-UW Research Institute for Aging found that doctors prescribed antipsychotics to more than one-third of Parkinson’s patients in long-term care, while only 10 per cent were experiencing severe aggression or psychosis.
“There are a lot of people who are getting medication for which there isn’t an indication,” said Dr. George A. Heckman, a professor in UW’s faculty of applied health sciences and Schlegel Research Chair in geriatric medicine.
Antipsychotic medications can treat symptoms of dementia and other neuropsychiatric symptoms of Parkinson’s, but guidelines suggest they be used only for those people with severe agitation, aggression or psychosis who may be a danger to themselves or others.
That’s because there are serious risks associated with this kind of medication, especially for patients with Parkinson’s — the second most common neurodegenerative disorder after Alzheimer’s disease that affects 100,000 Canadians.
Parkinson’s patients can develop dementia, which may lead to the use of physical or chemical restraints including antipsychotics in long-term care facilities.
“The drugs are particularly tricky to use in these patients,” Heckman said.
They can worsen Parkinson’s symptoms and hamper mobility by slowing movement and making muscles more rigid. “(Patients) may start falling more or have trouble swallowing.”
Swallowing difficulties can lead to pneumonia, and the medication can also increase the risk of stroke or heart attack.
Considering those potential dangers, prescribing antipsychotics without benefits to a person’s quality of life is concerning to the researchers.
The study, published in the Journal of Parkinson’s Disease, also found the use of physical restraints was frequent among long-term care residents with Parkinson’s, particularly among those who were male, disabled, cognitively impaired and incontinent.
Heckman said Ontario did slightly better than other provinces, but there has been an emphasis here in recent years on dealing with troublesome behaviour associated with dementia using measures other than restraints. Those include behavioural interventions, regular activity and a more stimulating environment.
More specialists supporting long-term care would also be helpful, educating staff about proper use of drugs and troubleshooting when problematic behaviour appears. Now there are few specialists helping in long-term care, even though more doctor visits are linked to less use of restraints and antipsychotic medication.
The study is part of the National Population Health Study of Neurological Conditions — one of the largest Canadian studies ever conducted on Parkinson’s disease.