Nearly a quarter of Winnipeg care home residents given antipsychotic drugs with no diagnosis
Health authority pledges 'renewed focus' on the use of drugs after increase in 2022
Winnipeg nursing home residents are being prescribed powerful antipsychotic drugs at an increasing rate to treat dementia and control behaviour, rather than what the drugs are meant for — to manage symptoms of schizophrenia or bipolar disorder.
More than 23 per cent of personal care home residents were prescribed antipsychotic medication without a diagnosis of psychosis in the first three months of 2022, according to data provided by the Winnipeg Regional Health Authority.
That average is the highest percentage reported by the WRHA in seven years.
Trish Rawsthorne, a Manitoba seniors' advocate and former nurse, saw first-hand what happens to someone put on an antipsychotic after her sister was given the drug risperidone over a decade ago.
"When she was on the medication, she was very frightened. She didn't really know what was going on. She lost the ability to speak. She was walking 12 hours a day. She couldn't eat properly," Rawsthorne said.
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In 2011 her older sister, Linda, then 65 years old, was put on the drug to treat severe anxiety stemming from dementia, caused by a series of concussions earlier in her life.
Antipsychotics like risperidone are used to treat a variety of mental health conditions, but mainly for conditions that include psychotic symptoms, such as schizophrenia or bipolar disorder.
Risperidone can be used in the short term to treat severe dementia of the Alzheimer's type, according to Health Canada.
When her sister was moved to Misericordia Place nursing home around 2013, Rawsthorne made it her goal to get her sister off the drug.
"I said, 'This is absolutely ridiculous' … I wanted her to be able to live as normally as possible and to retain whatever memories she had," Rawsthorne said.
When she was able to show the doctor at the nursing home the effect the drug had on Linda, he agreed to wean her off.
"She came back to her [old] self," Rawsthorne said.
But if she hadn't advocated for it, she doesn't think her sister would ever have been taken off the drug.
Linda died in 2019, but "at least she had times when she knew who I was, who the family were, and she could have moments of enjoyment," said Rawsthorne.
Which homes prescribe the most?
Nationally, 22 per cent of residents were receiving antipsychotic medications while having no clinical indication of their necessity, according to 2020-21 figures from the Canadian Institute for Health Information.
Fifteen of the 38 homes in Winnipeg prescribed above that national average, and seven reported 30 per cent or more of their residents were prescribed an antipsychotic without a diagnosis in the first three months of 2022, according to the regional health authority's data.
Holy Family Nursing Home, which has 286 beds, and Deer Lodge Centre, with 235 beds, had the highest percentages in Winnipeg. Both reported more than 37 per cent of their residents were using these drugs without a diagnosis.
Those higher percentages may be because both of those homes have "special needs behavioural units," which house residents with complex psychological needs, a health authority spokesperson told CBC.
The 175-bed Beacon Hill Lodge, owned by Revera, was the only Winnipeg nursing home that reported no residents were prescribed antipsychotics without a diagnosis.
A spokesperson with the for-profit company said that's the result of a team effort that involved finding different strategies to manage dementia and looking for options beyond medication.
- Click here to see the percentages for all Winnipeg nursing homes
The Convalescent Home of Winnipeg had the second-lowest percentage, with six per cent of the residents in its 84-bed facility on antipsychotics without a diagnosis.
In Manitoba, there is no tracking system in place outside Winnipeg for personal care homes when it comes to antipsychotics being given without a diagnosis.
Dangers of antipsychotics well documented
Elderly patients with dementia who are treated with antipsychotics have an increased risk of death, mostly due to cardiovascular concerns and infections, according to Health Canada.
Other studies have shown the drugs can increase the risk of falls and fractures in older adults.
"You almost put this person into a zombie-like state," said Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network in Toronto.
"These medications can come with risks. There can be increased risks of movement disorders. There can be increased risks of dying overall, increased risk of stroke."
A spokesperson for the Winnipeg Regional Health Authority acknowledged the average rate of residents on antipsychotics without a diagnosis is rising, and is at its highest point since 2015.
It dropped as low as 18 per cent in 2018, but has been climbing steadily since.
The new numbers have put a "renewed focus" on the use of these medications in nursing homes, as "there may be alternatives to the use of antipsychotics in managing behavioural and psychological symptoms of dementia," the spokesperson said.
An "influx of admissions" to nursing homes this year after capacity was reduced during the start of the COVID-19 pandemic is partly to blame, according to the spokesperson.
However, Sinha says the problem may be linked to staffing issues at care homes.
"It's why these behaviours become more problematic for example, and harder to manage — especially when you're short-staffed," he told CBC.
"People sometimes then just reach for these medications, even though we know if we were just properly staffed and we could properly provide the care that people needed, we wouldn't even have to resort to these medications at all."
The health authority spokesperson said care home residents get a medication review every three months.
In response to the increasing numbers, the reviews for this quarter have focused on "deprescribing antipsychotic medications," and options to reduce doses have been discussed with residents and their medical care teams.
As was the case for Rawsthorne's sister, residents often come into a care home already on psychotic medication, the spokesperson said.
Rawsthorne thinks in order to effect change, nursing homes have to shift how they care for residents, with a focus on creating home-like environments where seniors can thrive.
"I just think there has to be a change in how we look after people," she said. "And I think if we do that, we're going to find that we don't need to use antipsychotic drugs."
Use of antipsychotics without a diagnosis in Winnipeg nursing homes:
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With files from Matthew Pierce