Psychotropic Drug Utilization in Long-Term-Care Facilities for the Elderly in Ontario, Canada

Abstract

Objective: Despite considerable data from a number of countries regarding psychotropic utilization in long-term-care facilities for the elderly, there has been a lack of similar data from Canada. The purpose of this study was to gather prescription data from a series of institutions in Ontario and to compare the results to those of other international studies. Method: Single-day surveys were carried out in six homes for the aged, four nursing homes, two retirement homes, and a veterans' center. The results were compared to those of recent studies from other countries. Results: The data revealed considerable differences in rates of prescription between different classes of institutions and between similarly classified institutions. The prescription rate of neuroleptics ranged from 11.8% (of patients) in retirement homes to 29.8% in nursing homes. Antidepressant use ranged from 12.2% in nursing homes to 24.6% in homes for the aged, and benzodiazepine use ranged from 22.5% in nursing homes to 36.4% in retirement homes. Conclusions: The overall rate of prescription for psychotropic medications was somewhat lower than in most international studies. The rate of prescription of neuroleptics in nursing homes fell in the midrange of studies, somewhat higher than in recent studies from the United States and an earlier Italian study, but lower than in recent reports from Sweden, Austria, and Australia. The rate of neuroleptic use in homes for the aged was comparable to the rate in the U.S. studies. The overall rate of prescription of antidepressants and benzodiazepines appears to be comparable to that in recent studies from other countries.

Antipsychotic drug use in Canadian long-term care facilities: prevalence, and patterns following resident relocation

“…Our rates are similar, however, to the rates of 28.8% (Snowdon et al, 1995) and 30.7% (Snowdon and Vaughan, 1997) found in Australia, and the rate of 29.8% found in another Canadian study (Conn et al, 1999). Taken together, our study and the Conn et al (1999) study suggest that Canadian rates of antipsychotic use in LTC facilities may be among the highest in the developed world, and close to the high rates found in the U.S.A. before the introduction of the OBRA legislation limiting antipsychotic use (Avorn et al, 1989;Ray et al, 1980).…”

“…Taken together, our study and the Conn et al (1999) study suggest that Canadian rates of antipsychotic use in LTC facilities may be among the highest in the developed world, and close to the high rates found in the U.S.A. before the introduction of the OBRA legislation limiting antipsychotic use (Avorn et al, 1989;Ray et al, 1980). Regardless of the many potential reasons that may contribute to these comparatively high rates found in this and the Conn et al (1999) study -and whether one sees these figures as evidence that laws and legislation are the most effective way to improve medical and nursing practice in nursing homes (Hughes, 2000) -these initial results highlight the need for more Canadian research. Furthermore, the findings are suggestive of the potential need for Canadian nursing homes to monitor more carefully the appropriate use of antipsychotic medications and/or consider the use of educational programs for physicians and nursing staff on the use of antipsychotics in LTC (Rovner et al, 1996).…”

“…However, there are very few studies on the use of antipsychotics in Canadian nursing homes. One Western Canadian study found a rate of 17% (Earthy et al, 2000) and another Eastern Canadian study found a rate of 29.8% (Conn et al, 1999). More Canadian research is needed, particularly since Canada, unlike the U.S.A, has no mandatory regulations limiting the use of antipsychotics in nursing homes.…”

Prevalence of psychotropic drug use in nursing homes for the aged in Quebec and in the French-speaking area of Switzerland

“…In comparison with the elderly population in general, the psychotropic use was clearly higher among this elderly institutionalised sample, but this does not mean that use was more inappropriate (Conn et al, 1999;Newman and Hassan, 1999). Even if drug use is higher after admission to a nursing home, it can be also more appropriate (Dhalla et al, 2002).…”

Psychiatric Complications of Dementia

“…31 Other Canadian studies found rates of 17% 32 to 30%. 33 Antipsychotic medications are associated with risks, such as falls and tardive dyskinesia, that rise considerably in older people. 31 …”