A disproportionately high number of people admitted to long-term care facilities during the COVID-19 pandemic's first year were on antipsychotic medications, recently published Brock-led research has found.
The newly arrived residents, who mostly came from hospitals and community settings, were also prescribed these drugs without a psychosis diagnosis, says the study's lead author, Assistant Professor of Health Sciences Luke Turcotte.
"When a person doesn't have any indications of psychosis, then we consider these medications to be potentially inappropriate for this population," he says. "Because people on antipsychotic medications are at greater risk of falls, stroke and all-cause mortality, these shouldn't be the first line of treatment for persons living with dementia."
In their study, "Antipsychotic Medication Use Among Newly Admitted Long-term Care Residents During the COVID-19 Pandemic in Canada," the research team identified about 84,000 people who were newly admitted to long-term care facilities in Alberta, British Columbia and Ontario between March 5, 2018, and March 4, 2021.
New admissions were grouped into categories based on the referral sources, including hospitals, assisted living facilities and private homes, in-patient continuing care and rehabilitation facilities, psychiatric wards and other sources.
Using data from the Canadian Institute for Health Information (CIHI), the research team compared antipsychotic medication use among people admitted before and during the COVID-19 period who had not been diagnosed with psychosis, as well as where they came from.
The rate of "inappropriate prescriptions" for newly admitted residents rose from 22 per cent in 2018-19 to 27 per cent in 2020-21, the study says.
The researchers also found fewer residents underwent a process called "deprescribing," where patients are taken off medications that may no longer be needed or could be causing harm.
Turcotte says antipsychotic medications are often used "off-label" to manage behaviours such as agitation, aggression and resistance to care, which are ways that persons living with dementia may express unmet needs and concerns.
"It's unclear why antipsychotic use in hospitals increased," he says. "It's likely that visitor restrictions limited families' ability to support and advocate for their loved ones in the unfamiliar and potentially distressing hospital environment."
This latest research follows up on a previous study Turcotte published last year. It examined the impact of the pandemic on numerous measures of quality of care in Canadian long-term care homes and found an increase in antipsychotic drug use was widespread in Canadian long-term care facilities during the first year of the pandemic.
The current study, published last month, did a deeper dive on this issue. It revealed that some of this increase was due to people arriving at long-term care facilities already on the antipsychotic medications coupled with a lower deprescribing rate within the first three months of their stay.
Turcotte says delirium prevention initiatives, like Ontario Health's Delirium Aware Safer Healthcare (DASH) campaign, are part of the solution.
"These medications are often first administered to treat delirium, and their use can persist after the person leaves the hospital," he says. "It's important that we continue to empower health-care professionals to use person-centred approaches that put an emphasis on understanding each person's life story and tailoring care to their individual needs."
Led by Turcotte, the research team includes researchers from St. Joseph's Health Care in London, Western University, the Lawson Research Institute in London, Dalhousie University in Halifax, SE Health in Markham, University of Toronto, University of Waterloo, St. Joseph's Health System, and Sinai Health, Toronto.
