New Study Looks At The Effects Of Antipsychotic Medication On Long-Term Care Residents

A new study published in the Journal of the American Medical Directors Association looked at a longitudinal treatment effect analysis of antipsychotics on the behavior of residents in long-term care.

“Our study was focused on the use of advanced statistical methods to evaluate the effects of antipsychotic use among nursing home residents who do not have existing conditions associated with psychosis,” study author, Dr. John Hirdes told us. Dr. Hirdes is a professor in the School of Public Health Sciences. “These drugs are often use ‘off label’ to manage behaviours in persons with dementia. We wanted to determine whether these drugs would be effective in managing behaviour problems in long-term care.”

The researchers were examining whether the off-label use of these medications is in fact beneficial for managing behaviours in long-term care. The use of antipsychotic medications in the absence of indicators of psychosis is considered to be a marker of potentially inappropriate use of these drugs and is publicly reported as an indicator of the quality of care in long-term care homes. 

“We used an advanced statistical method known as treatment effects analysis (TEA) which allows you to emulate experimental trial results using observational data,” Dr. Hirdes told us. “This method allowed us to use data from a very large representative sample of persons receiving care in Canadian long-term care homes.” 

The study results showed that antipsychotic medications were associated with a 26% increase in the odds of worsening behaviour among long-term care home residents after adjusting for many cofounding variables. 

“These drugs did not help,” Dr. Hirdes told us. “They made things worse. The justification for off label use of these medications is to manage behaviour problems in persons with dementia in long-term care. These results suggest that these medications actually make those problems worse.” 

These results lend further support to efforts to reduce the potentially inappropriate use of antipsychotic medications in long-term care and further justify public reporting of this use of these drugs. Long-term care homes in Canada need to place greater emphasis on person-centred non-pharmacological approaches to dealing with challenging behaviours. This may include better funding from government to enhance staffing levels, better access to appropriate mental health expertise, and a focus on addressing the underlying factors that can affect behaviours in long-term care.

“Other countries, including the United States, have made greater progress in reducing the inappropriate use of these medications in long-term care,” Dr. Hirdes told us. “In addition, my team has been working with a collaborative community of practice comprised of leading long-term care homes in Canada, the United States and South Africa known as the Seniors Quality Leap Initiative (SQLI). The SQLI network has been undertaking collaborative efforts to improve patterns of antipsychotic use in these countries.”

 

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