A recent investigation by researchers from the University of Waterloo examined the records of nearly 500,000 Canadian nursing home residents over the years 2000 to 2022. The findings revealed that those who received antipsychotic medications experienced a notable decline in their behavior. Specifically, about 68 percent of these residents displayed increased behavioral issues during subsequent evaluations.
According to Dr. Daniel Leme, the principal author of the study and a postdoctoral researcher in Waterloo’s School of Public Health Sciences, “This is the first national longitudinal study of its kind, utilizing a statistical method to assess the impact of antipsychotic medications.”
Antipsychotic drugs are often prescribed “off-label” in nursing homes, which means they are utilized for purposes that are not sanctioned by health regulatory bodies such as the U.S. Food and Drug Administration (FDA). For instance, these medications might be used to address behavioral symptoms linked to dementia, despite being approved solely for disorders like schizophrenia or specific psychotic conditions. The research indicated that between 2014 and 2020, 26 percent of nursing home patients in Canada received antipsychotics in non-recommended ways according to FDA guidelines.
While antipsychotics may be used to pacify residents exhibiting aggression or agitation, these drugs can lead to severe side effects. Potential adverse reactions can include tremors, restlessness, stiffness, painful muscle contractions, and difficulty standing or walking, which may worsen pre-existing behavioral and psychological issues.
Dr. John Hirdes, a professor in the School of Public Health Sciences, commented, “Sometimes it’s claimed that there isn’t enough staff to manage these situations, but the truth is these medications can exacerbate disability and cognitive challenges. We need to evaluate the appropriateness of using antipsychotics on individuals who do not have psychosis-related conditions.”
The study highlights the incorrect use of antipsychotic medications for treating behavioral and psychological symptoms of dementia (BPSD), which can manifest as irritability, aggression, agitation, anxiety, depression, shifts in sleep or appetite, apathy, wandering, repetitive questioning, inappropriate sexual behaviors, and refusal to receive care.
Researchers advocate for a shift away from immediate medication intervention, proposing a focus on personalized care that addresses the underlying reasons for a resident’s behavior while providing alternative forms of support. For example, a resident might benefit from enhanced pain management, improved communication, or activities aimed at alleviating anxiety. Non-pharmaceutical interventions such as music, art, social engagement, and gentle exercise have proven effective in managing behaviors without resorting to antipsychotics.
Furthermore, equipping staff with knowledge about the dangers of antipsychotic medications and training them to provide better care has been associated with positive results for nursing home residents, including reduced agitation and improved overall quality of life.
This study, published in the November 2024 issue of the Journal of the American Medical Directors Association, is part of a broader international initiative known as I-Care4Old and was funded by the New Frontiers Research Fund Global Grant.
