HQO report shows variations across Ontario's long-term care homes regarding antipsychotic drug use

There are major differences across Ontario's long-term care homes in the percentage of residents who are being prescribed antipsychotic medications, according to Looking for Balance, a report from Health Quality Ontario (HQO), the provincial advisor on health care quality.

In some long-term care homes, no residents over age 65 are being prescribed antipsychotic medications, while in others, up to two-thirds of the residents are being prescribed the drugs. The report notes that some of the variation across the province could be due to the fact that some homes specialize in treating people with severe mental illness or advanced dementia. But it is unlikely this factor alone explains the breadth of these differences.

Antipsychotic medications are often prescribed to control symptoms of psychosis, and to manage agitated and aggressive behaviours associated with dementia, such as hitting or yelling, which can put residents – or those around them – at risk. But the use of these drugs must be weighed against their side effects, which include a higher risk of falls, symptoms that affect quality of life (like sleeping all day), and possibly a small increased risk of death.

"Because of the side effects, there is a lot of debate right now in Ontario and across Canada about how best to prescribe antipsychotic medications," said Dr. Joshua Tepper, President and CEO of HQO. "The variation underscores the importance of carefully considering these medications for each person living in long-term care homes, so that only those residents who would most benefit are using them."

Although there is variation from one home to the next, the report found that overall there was slightly less use of these medications in long-term care homes than there was four years ago. The percentage of residents being prescribed antipsychotic medications in Ontario has decreased from 32 percent in 2010 to 29 percent in 2013.

Looking for Balance includes real stories from some long-term care home residents and their families who have benefitted from antipsychotic medications, as well as others who saw improvements after tapering off the drugs. These stories highlight the resident and family experiences with these medications and show how challenging and rewarding it can be to find the right balance. The report also explores how care teams are working with residents and their families to balance antipsychotic medication use by tracking medication data, creating innovative programs, assessing individual residents and engaging families.

"This report provides a snapshot of the current state of antipsychotic medication use and identifies opportunities to learn about practices that are improving the lives of Ontarians living in long-term care homes," adds Dr. Tepper. "We hope to spark conversations that allow people to learn from each other about their different approaches to common challenges."