Cutting inappropriate prescriptions of antipsychotics leads to dramatic reductions in falls and abusive behaviour in long-term care homes, a new study shows.
Researchers found that, by doing a case-by-case review, they were able to eliminate or reduce the use of the powerful drugs in 54 per cent of patients to whom they had been prescribed.
This, in turn, over a one-year period, lead to a:
- 20-per-cent decrease in falls;
- 33-per-cent drop in verbal abuse of staff;
- 28-per-cent reduction in physical assault of workers;
- 26-per-cent fall in inappropriate behaviour;
- 22-per-cent decrease in resistance to care.
Just as importantly, the use of physical restraints did not increase.
The results are particularly striking because antipsychotics are often prescribed to control aggression and resistance to care.
"Antipsychotics are being prescribed to patients with dementia, not psychosis, and our initiative demonstrates this is of limited benefit and can cause serious harm," Stephen Samis, vice-president of programs at the Canadian Foundation for Healthcare Improvement, said in an interview.
In fact, he said, "aggression and other negative behaviours that these drugs were supposed to control actually fell when the drugs were stopped."
The CFHI, which sponsored the study, worked with 56 long-term care homes across the country to examine the impact of deprescribing after earlier research showed that nearly half of LTC residents were being prescribed antipsychotics, which are often described as "chemical restraints."
Mr. Samis said one of the most interesting findings was that 81 per cent of patients already had a prescription for antipsychotics before moving to a long-term care home.
"The homes are often blamed for this but the over-prescribing problem is actually in the community and in hospitals," he said.
Several provinces have already undertaken antipsychotic-reduction programs, but there are still wide variations between care homes.
The CFHI said that its priority is to scale up the initiative nationally to eliminate inappropriate antipsychotic prescriptions, and it commissioned an analysis from RiskAnalytica to calculate the potential savings.
Based on the finding that 27.5 per cent of long-term care residents are current prescribed an antipsychotic, even though they don't suffer from psychosis, they estimated that within five years, 35,000 LTC residents could have their antipsychotics reduced or discontinued, and 25 million antipsychotic prescriptions could be avoided altogether.
The decline in inappropriate prescriptions would, in turn, prevent 91,000 falls, 19,000 ER visits and 7,000 hospitalizations over a five-year period. (That is equivalent to an 8-per-cent decline.)
All told, the projection is that $194-million would be saved, even after the costs of implementing the program are taken into account.
One province, New Brunswick, was so impressed by the results it achieved in the York Care Home in Fredericton that, within two years, it will expand the deprescribing program to all 62 long-term care homes in the province.
Mr. Samis said that overprescription of antipsychotics is just one part of a larger issue.
"The big take-home message here is that Canada has a problem overmedicating seniors and we can't afford to sit back and do nothing about it," he said.