Antipsychotics overprescribed to Quebec seniors with dementia: report

An investigative report by Le Soleil revealed that between 30 and 50 per cent of seniors with dementia in the province's CHSLDs are prescribed antipsychotic medications.

Nurse and nursing professor Philippe Voyer says antipsychotics improperly used in up to half of cases

A report suggests Quebec seniors with dementia are being overprescribed antipsychotic medication.

A new exposé conducted by a Quebec City newspaper suggests Quebec nursing homes are overmedicating seniors with dementia, despite multiple warnings from Health Canada warning against the usage of antipsychotics in this capacity.

An investigative report by Le Soleil revealed that between 30 and 50 per cent of seniors with dementia in the province's CHSLDs are prescribed antipsychotic medications. That figure should be closer to 10 per cent, according to Philippe Voyer, a registered nurse and professor of nursing science at Université Laval in Quebec City.

Voyer told Quebec AM on Monday that he's personally witnessed the overprescription of antidepressants and antipsychotics in seniors' homes.

"The side effects of these drugs and the limitations of their efficacy are well-known, but the problem is we still use it a lot among people with dementia in long-term care facilities," said Voyer.

He said many senior care facilities use the drugs to help regulate persistent behavioural and mental disturbances experienced by residents. Health Canada has issued at least four warnings against the long-term usage of antipsychotics, he continued.

Health Canada warning (Feb. 2015):

"The indication for risperidone in dementia has been restricted to the short-term symptomatic management of aggression or psychotic symptoms in patients with severe dementia of the Alzheimer type unresponsive to non-pharmacological approaches and when there is a risk of harm to self or others. The indication no longer includes the treatment of other types of dementia such as vascular and mixed types of dementia."

"These drugs were not designed for this," Voyer said.

Rather, he said, the drugs are meant to be used for short-term problems -- for example, if the resident is experiencing psychological distress so severe nurses can't interact with him or her.

"We know about 20 per cent of drugs prescribed are effective for behavioural disturbances," Voyer said.

On top of that, he said, dementia patients have shown improved cognitive capacity and improved behaviour once they get taken off of antipsychotic medication.

Voyer said that ideally the target percentage of dementia patients taking antipsychotics and antidepressants should be about 10 per cent of the total residence population.

He said better training and more motivation could drastically improve the situation in the province's long-term care facilities.


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