At any point in time, there are approximately 77,000 Ontario residents in nearly 620 long-term care homes across the province. Data shows that over the last five years, 35% fewer residents have been taking antipsychotics, a class of drugs used to treat psychosis. Despite this recent decrease in the use of antipsychotic medications, prescribing of other medications is still high, and polypharmacy is rampant.
According to the Canadian Institute for Health Information, 61% of residents in Ontario long-term care homes are taking 10 or more different prescription medications concurrently and seniors who use multiple medications are at an increased risk of adverse effects and drug interactions. Specifically, for elderly patients, psychotropic drugs appear to be linked to an increased number of falls, and the use of antipsychotics for dementia is associated with increased morbidity, adverse events and hospitalization.
According to Zou & Tannenbaum (2014), as the elderly population and long-term care populations grow, there will be an increased demand for pharmacists to take on shared responsibility for effective and safe prescribing in older adults. Read their report on Educational needs, practice patterns and quality indicators to improve geriatric pharmacy care. Currently underway in Ontario is the
Appropriate Prescribing Demonstration Project (APDP), (Desveaux et al. 2016) which is investigating the effect of adding academic detailing to audit and feedback on prescribing behaviour; read the study protocol and stay tuned to find out how appropriate prescribing is evolving in Ontario.
Polypharmacy in long-term care is an issue in many jurisdictions. For an international example, consider this systematic review by Jokanovic et al. (2015) from the Faculty of Pharmacy at Monash University in Australia about the prevalence and factors associated with polypharmacy in long-term care facilities. The authors’ findings indicate a need to explore the causes and consequences of polypharmacy’s evolution longitudinally.
Some interesting local resources around prescribing and de-prescribing include The Centre for Effective Practice’s guide, How Antipsychotic Medications are Used to Help People with Dementia, and the Seniors Health Knowledge Network’s various tools for medication management and polypharmacy.
What tools or resources do you know of that help you prescribe safely to older individuals and long-term care residents? Is there any work underway in your area to ensure safe prescribing for this population?