Antipsychotic drugs use increased in Canadian long-term care homes, pointing to possible quality-of-care issues: study

A new study has revealed an increase in antipsychotic drugs use in long-term care homes across Canada despite no significant increase in behavioural symptoms of residents – something that may expose a potential area of concern for quality of care, researchers say.

The study, published in Health Services Insights, examined data from yearly Canadian Institute for Health Information (CIHI) reports to assess how COVID-19 impacted resident admission and discharge rates, resident health attributes, treatments, and quality of care.

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The report data was collected two years pre-pandemic and in the first year of COVID-19, and was from more than 500,000 residents across Ontario, Manitoba, Alberta, and British Columbia.

The researchers focused on these provinces as they were home to facilities with the highest number of COVID-19 cases early on in the pandemic.

There was approximately 10 per cent in risk-adjusted odds of potentially inappropriate antipsychotic drug use across the provinces studied, compared with the pre-pandemic period, according to John Hirdes, professor at the School of Public Health Sciences at the University of Waterloo.

The risk-adjusted rates for inappropriate use of antipsychotic drug usage without a diagnosis indicate that usage in Alberta went from 18.1 per cent in 2019/2020 to 19.9 per cent in 2020/2021. In Ontario, usage went from 18.3 per cent in 2019/2020 to 19.3 per cent in 2020/2021.

Additionally, researchers said the number of people who were given antipsychotics without being diagnosed as psychotic increased in all provinces, not just the four that were studied.

"The highest increase was in Alberta, and the lowest in Ontario," researchers said.

This increase may expose a potential area of concern for quality of care, as the researchers did not observe a significant increase in behavioral symptoms of psychosis that would lead patients to require antipsychotic drugs.

“(This) raises the question of whether these medications were used pre-emptively in anticipation of challenges during outbreaks and staffing shortages," said Hirdes, in a press release.

The pandemic was particularly challenging to long-term care homes, many of which were inundated with COVID-19 patients requiring care. However, all other quality indicators studied in the research remained stable, which Hirdes says reflects positively on the efforts of staff in long term care homes.

The study authors write that while the pandemic weaknesses in the heath sector --- such as of infection practice and controls, emergency preparedness, and staffing supports in health care --- the data showed a similar quality of care compared to pre-pandemic times in all other aspects.

The authors say that more research should be done to better understand the impact of COVID-19 outbreaks on health care facilities and the quality of care received by the residents.

The prescription of antipsychotic medications is used to reduce or relieve symptoms of psychosis, including delusions and hallucinations, according to the Centre for Addiction and Mental Health (CAMH).

These drugs are also known as treatment for psychosis that occurs for those with bipolar disorder, depression, and Alzheimer’s disease, as well as for those with schizophrenia.

According to CAMH, these drugs have unpleasant side effects, including dizziness, weight gain, and diabetes, most of which will go away after stopping drug use. There is however risk for a long term condition called tardive dyskinesia, which causes people to make involuntary movements.