Antipsychotics and Sedative Use in Long-Term Care

In fiscal year (FY) 2012, there were 93,489 ODB beneficiaries living in LTC homes in Ontario, 38.0% (N=35,506) of whom were dispensed an antipsychotic.
Among LTC residents, 2.7% (N=2,600) received only first generation antipsychotics, 31.5% (N=29,405) received only second generation antipsychotics and 3.7% (N=3,501) received both first and second generation antipsychotics (i.e. mixed group) over the year.
The prevalence of antipsychotic use decreased as age increased, from 46.2% (N=1,814 of 3,924) among patients aged 65-69 to 24.2% (N=277 of 1,144) among patients aged 100-104.
This trend in antipsychotic use by age was observed for first generation (4.1% aged 65-69 to 2.7% aged 100-104), second generation (35.0% aged 65-69 to 19.8% aged 100-104) and the mixed group (7.1% aged 65-69 to 2.8% aged 100-104) antipsychotics.
Concomitant antipsychotic and sedative use:
- 27.1% (N=25,286) of LTC residents received antipsychotics with no concomitant sedatives, 10.9% (N=10,220) were treated concomitantly with antipsychotics and sedatives, and 6.2% (N=5,826) were chronically treated with both antipsychotics and sedatives.
Concomitant antipsychotic and cholinesterase inhibitor (ChEI) use:
- 13.3% (12,470) of LTC residents were treated concomitantly with antipsychotics and ChEIs, the majority of which (91.4%; N=11,397) had chronic ChEI use.

In 2012, 26.9% (N=25,184) of LTC residents had a prescription for a sedative.
The use of sedatives in LTC homes tended to decrease with age. Sedative use was highest among patients aged 65-69 (34.8%; N=1,353 of 3,890), falling to 25.7% (N=13,334 of 52,036)among patients aged 85 and older.

Antipsychotic use with any concomitant sedative use:

In LTC homes, the number of patients taking an antipsychotic with a concomitant
sedative decreased with increasing age:
- 20.0% of LTC patients aged 65-69 (N=735 of 3,924) used both antipsychotics and sedatives.
- 5.1% of LTC patients aged 100-104 (N=58 of 1,144) used both antipsychotics and sedatives.
This trend was observed for all types of antipsychotics.

Chronic use of both antipsychotics and sedatives:

In LTC homes, the number of patients chronically treated with both antipsychotics and sedatives also decreased with increasing age:
- 13.5% of LTC patients aged 65-69 (N=531 of 3,924) were chronically treated with both agents.
- 2.3% of LTC patients aged 100-104 (N=26 of 1,144) were chronically treated with both agents.
This trend was observed for all types of antipsychotics.

There is concern that antipsychotics and sedatives are being used inappropriately in LTC homes.
The Ontario Public Drug Program has requested information on use of antipsychotics, sedatives and cholinesterase inhibitors among ODB beneficiaries in LTC homes, to inform discussions regarding the inappropriate prescribing of these medications.

While use of antipsychotics and sedatives appears high, their appropriateness could not be established with the data currently available.
More information is needed on the indication of use as well as on the specific products being prescribed to determine the appropriateness of antipsychotic and sedative use in LTC homes.