Doctor with pill bottle, spilling medication into hand

A new JAMDA study reveals a startling trend in how people with dementia are being medically managed in long-term care facilities in Nova Scotia. It found that 90% of all antipsychotic medications dispensed in this Canadian province are to long-term care residents.

The study comes as nursing homes in the United States are bracing for audits by the Centers for Medicare & Medicaid Services to determine whether residents’ schizophrenia diagnoses are accurate and appropriately coded.

The study investigated the use of antipsychotic medications in residents aged 66 and up at 92 long-term care facilities in Nova Scotia between 2009 and 2016. Almost half of the residents in the study received an antipsychotic medication at least once each year during the study period. The top medications noted in the study included quetiapine, risperidone, and olanzapine.

Overall, the study authors determined that the proportion of men receiving antipsychotics was higher than women; however, the greater number of women residing in long-term care made the number of antipsychotics dispensed to them larger overall.

The use of antipsychotics is not inappropriate in these patients, but as the total number of people with dementia is expected to triple by 2050, more attention is being paid to the use of these medications, and their unintended effects.

In addition to tracking the use of these medications, the study also investigated how and why patients who received antipsychotics were hospitalized. The report found that more than 1,000 patients in a Nova Scotia pharmacy benefit program for seniors were prescribed an antipsychotic in the months leading up to a fall-related hospitalization, and about half of them were living in long-term care facilities at the time. Most survived their fall-related hospitalization, but the study notes that many also continued their antipsychotic medications after discharge.