by University of Waterloo

Balancing covariates before and after PS matching and weighting by selected individuals' characteristics. Note: Black dotted lines represent standardized mean differences between − 0.10 and 0.10 indicating adequate balance. Red objects represent the standardized mean difference before PS. Blue and green objects represent the standardized mean difference after PS matching and weighting, respectively. Credit: Journal of the American Medical Directors Association (2024). DOI: 10.1016/j.jamda.2024.105255

A new study conducted by researchers at the University of Waterloo analyzed data from nearly 500,000 Canadian patients who lived in nursing homes across Canada between 2000 and 2022. It found that residents who were given antipsychotic medications showed a significant worsening of their behaviors. In fact, nearly 68% of residents who used antipsychotics had more problems with their behavior during follow-up checks.

"This is the first national longitudinal study of its kind, using a statistical technique to measure the effect of antipsychotic treatments," said Dr. Daniel Leme, the study's lead author and a postdoctoral scholar in Waterloo's School of Public Health Sciences.

The research is published in the Journal of the American Medical Directors Association.

Antipsychotics are often prescribed in nursing homes "off-label," meaning they're used for purposes not approved by health authorities like the U.S. Food and Drug Administration (FDA). For example, they might be given to manage behaviors associated with dementia, even though these drugs are only approved for treating conditions like schizophrenia or certain types of psychosis. The study found that 26% of nursing home residents in Canada were given antipsychotics in ways not recommended by the FDA between 2014 and 2020.

Although antipsychotics are often used to calm residents with aggressive or agitated behavior, the medications can have serious side effects. These include tremors, restlessness, rigidity, painful muscle contractions and the inability to stand and walk, which can exacerbate existing behavioral and psychological symptoms.

"Sometimes people may say they don't have enough staff to deal with these issues, but the reality is that these medications can make disability and cognitive impairment worse," said Dr. John Hirdes, a professor in the School of Public Health Sciences. "We need to seriously reconsider the use of antipsychotics for people who do not have conditions associated with psychosis."

The study outlines the inappropriate use of antipsychotics to treat behavioral and psychological symptoms of dementia (BPSD), which can include irritability, aggression, agitation, anxiety, depression, sleep or appetite changes, apathy, wandering, repetitive questioning, sexually inappropriate behaviors and refusal of care.

Instead of turning to medication right away, researchers suggest focusing on person-centered care—getting to the root causes of a resident's behavior and offering support in other ways. For example, a resident might need better pain management, clearer communication, or activities to help reduce anxiety. Non-drug therapies like music, art, social interaction, and gentle exercise have been shown to help manage behavior without the need for antipsychotics.

Training staff to understand the risks of antipsychotics and how to offer better care has also been linked to improved outcomes for nursing home residents, including less agitation and a better quality of life.

More information: Daniel E.C. Leme et al, A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care, Journal of the American Medical Directors Association (2024). DOI: 10.1016/j.jamda.2024.105255

Provided by University of Waterloo