Too many seniors in nursing homes given dangerous medications

by Jesse McLean & David Bruser for The Star:

Nearly half of Canada’s vulnerable seniors living in nursing homes were given drugs flagged for being potentially dangerous and inappropriate, a new national health study has found.

A report by the Canadian Institute for Health information found 46.5 per cent of seniors living in long-term care facilities across the country claimed a prescription for a drug on the Beers list, a widely used index of medications deemed potentially unsuitable for seniors because of an increased risk of side effects and lack of efficacy.

Among the drugs on the list most commonly prescribed in Canadian nursing homes are antipsychotics, despite warnings that the powerful medications can kill elderly patients suffering from dementia. Nursing home residents were given antipsychotics nine times more often than seniors living in the community, the report found.

“The purpose of us producing these reports and putting these numbers out there is to really inform some discussions about what may be inappropriate prescribing,” said Michael Gaucher, CIHI’s director of pharmaceuticals and health workforce information services.

“When we see trends in the numbers that . . . in this case seem to be high, to us, it’s about creating awareness.”

An ongoing Star investigation has revealed some long-term care homes, often struggling with staffing shortages, are routinely doling out these risky drugs to calm and “restrain” wandering, agitated and sometimes aggressive patients.

At more than 40 homes across the province, roughly half the residents are on the drugs.

Nationally, about 41 per cent of nursing home residents received at least one antipsychotic in 2012, CIHI found.

The information the agency analyzed — 2012 data submitted by provincial and federal drug programs— did not include the reasons the medications were prescribed, Gaucher said.

While antipsychotics are given to nursing home residents with schizophrenia or other conditions the drugs are approved to treat, they are commonly prescribed “off label” for the unapproved use of controlling symptoms caused by dementia.

Experts say the drugs can be effective in treating dementia patients with severe aggression or agitation if other, non-pharmacological interventions have failed.

In these cases, Canadian clinical guidelines recommend three different antipsychotics while warning the drugs’ risks “must be carefully weighed against potential benefits.”

Quetiapine, the antipsychotic most routinely prescribed to Canadian seniors, isn’t one of them.

The drug, given to 1.6 per cent of Canadian seniors, carries the strictest possible warning on its label that it may cause increased risk of death and stroke in elderly dementia patients.

Doctors say the drug is sometimes given to sedate agitated nursing home residents at night to help them sleep.

A drug’s presence on the Beers list doesn’t mean it should never be prescribed, said the former president of the American Geriatrics Society, which recently updated and expanded the drug index.

“We say these drugs should be avoided. We also pointed out that there are situations where those agents may be needed. It’s up to clinical judgment,” Todd Semla said.

Still, he cautioned the prevalence of these drugs in Canadian nursing homes is “too high.”

“It should be half of what it is. I think that would be a safe assumption,” he said.

Other risky drugs on the list that are commonly given to Canadian seniors include antianxiety medication lorazepam, the diabetes drug glibenclamide and amitriptyline, an antidepressant.

The report, which analyzed data of nearly 3.5 million seniors who had claims for at least one prescription through public drug programs, also found:

• Nearly two-thirds of Canadian seniors are taking five or more prescription drugs. The numbers balloon inside long-term care homes, where 61 per cent of residents are taking 10 or more medications.

“When you add all the drugs together, certainly the risk of adverse effects with multiple drugs increases,” CIHI’s Gaucher said. “One of the takeaways is certainly to review patient medication on a regular basis. If you do that, certainly it presents an opportunity to identify medications that may no longer be needed or need to be changed because they’re causing a side effect.”

• In Ontario, 22.6 per cent of seniors received drugs identified on the Beers list as potentially inappropriate, just shy of the national average. The risky medications were most commonly doled out in New Brunswick, where 39 per cent of seniors claimed them through the provincial drug program.

Source: http://on.thestar.com/1i5n8mn