Promoting non-drug approaches

About 70 per cent of people in long-term care are women, many with some form of dementia. Antipsychotic drugs are widely prescribed in this vulnerable population to manage troublesome symptoms of dementia – behaviours like wandering, aggression and agitation. But these drugs, though approved to manage conditions like schizophrenia, have limited evidence to support their efficacy in managing dementia.

“Antipsychotics are used widely in this older population, but with real risks, particularly because of their age and health status,” says Dr. Paula Rochon. Rochon and her team discovered that about a third of residents in Ontario long-term care homes were being given antipsychotics.

“The majority of people in long-term care are women, and many have dementia,” says Rochon. “They aren’t in a position to advocate for themselves, yet this issue impacts them enormously.”

By limiting mobility and causing side effects like tremors and stiffness, antipsychotics can put frail older people in danger of health complications, falls and fractures. However Rochon and her team, whose study examined homes that all had very similar clientele, found that rates of antipsychotic use ranged widely – from 20 to more than 40 per cent.

“This disparity illustrates that some facilities are changing their cultures of care. They’re keeping residents healthy with systems that use non-pharmacologic approaches,” explains Rochon.

“Health complications and injuries from falls obviously hurt quality-of-life, but they also take a huge toll on our health-care system. There are extremely strong reasons to support the development of systems that reduce the use of antipsychotics in frail elderly people.”

Better systems are fueled, in part, by obtaining and disseminating knowledge that supports physicians, front-line workers and policymakers. In addition to publishing more than 20 peer-reviewed articles as a result of this work, Rochon’s team created educational materials to help front-line workers and policy-makers think outside of the box.

“We need to educate care workers and policy-makers so that we can implement better systems that improve care,” says Rochon. “We need to think about what we want for our parents, and ourselves.”

A geriatrician, Dr. Paula Rochon led the team that authored The Older Woman’s Health report, released as part of the POWER Study – a joint study from St. Michael’s Hospital and ICES (www.powerstudy.ca), and funded by Echo: Improving Women’s Health in Ontario (the Ontario Ministry of Health and Long-Term Care). The Older Women’s Health Report is the first in Ontario to examine women’s health in relation to income, education, ethnicity and geography. Rochon co-leads a team of researchers who are funded by the Canadian Institutes of Health Research. She is the vice-president of research at Women’s College Hospital, a senior scientist at WCRI, and a University of Toronto professor in the Department of Medicine and the Institute of Health Policy, Management and Evaluation.