Atypical antipsychotics are a newer generation of antipsychotics that are primarily approved for the treatment of patients with schizophrenia or bipolar disorder. However, the use of these drugs to treat behavioural and psychological symptoms (such as psychosis, agitation, aggression or other symptoms) in elderly patients with dementia has been greatly debated over the past several years.
“While many physicians who we interviewed find these drugs to be useful tools when managing behavioural issues in elderly patients with dementia, our systematic review suggests that the risks associated with these products may outweigh the benefits in many elderly patients when used inappropriately,” said Tara Gomes, a scientist at Li Ka Shing Knowledge Institute of St. Michael’s Hospital and the scientific lead of the Ontario Drug Policy Research Network.
“Furthermore, the rising use of these medications and variation in their use across Ontario suggests that there is a sizeable group of elderly patients who could be treated more safely and perhaps more effectively with other non-drug therapies,” said Gomes, who is also a scientist with ICES.
The Ontario Drug Policy Research Network conducted a large review of atypical antipsychotic use in the elderly to provide policy recommendations for use of these drugs in Ontario. That review was published on the network’s website today (www.odprn.ca).
Gomes said any policies designed to address the use of atypical antipsychotic drugs in the elderly must consider the limited options available to physicians in managing patients with difficult – and sometimes dangerous – behavioural issues related to dementia.
For this reason, one of the recommendations the researchers made is to implement programs aimed at identifying patients who would benefit from alternate therapies, with the goal of reducing inappropriate use of antipsychotic drugs for the elderly with dementia.
In addition to the increase in use of atypical antipsychotics overall, the review also found wide variation across Local Health Integration Networks for their use in the elderly living in the community and in long-term care homes. The review found:
- The Erie St. Clair LHIN (Sarnia-Windsor area) had among the highest rates of antipsychotic use in both long-term care homes and the community.
- The North Simcoe, Muskoka LHIN (Barrie-Orillia area) had the highest rate of community-based antipsychotic use.
- The North West LHIN (Thunder Bay-Kenora area) had the highest rate of antipsychotic use in long-term care homes, but the lowest rate of antipsychotic use in the community.
- The Mississauga LHIN had the lowest rate of antipsychotic use in long-term care homes.
“Although the rate of atypical antipsychotic use is higher in long-term care homes, two-thirds of all users live in the community, and approximately 40 per cent of those starting these drugs in the community end up moving to a long-term care home within one year,” Gomes said.
The drug class review also found:
- Use of atypical antipsychotics in the elderly with dementia almost doubles the risk of mortality.
- While there has been a 26 per cent increase in the use of atypical antipsychotics in elderly people who live in the community, the same five-year period saw a 2 per cent decrease in the use of these products in long-term care homes.
- The rate of use in long-term care homes is 328 per 1,000 elderly, compared to 22 per 1,000 elderly in the community.
- Although the rate of use is higher in long-term care homes, two-thirds of all users live in the community (72,488 in the community versus 32,580 in long-term care homes in 2013).
ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.
- For the latest ICES news, follow us on Twitter: @ICESOntario
- For the latest from the Ontario Drug Policy Research Network, follow us on Twitter: @ODPRN_Research
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
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