Sixty-eight percent of nursing home residents who were prescribed antipsychotics exhibited more behavioral issues after starting the medication compared to before.
Researchers at the University of Waterloo analyzed data from nearly 500,000 Canadian nursing home residents from 2000 to 2022. The study found that residents prescribed antipsychotic medications experienced a significant decline in behavior. Notably, follow-up assessments revealed that 68% of those using antipsychotics demonstrated increased behavioral problems.
“This is the first national longitudinal study of its kind, using a statistical technique to measure the effect of antipsychotic treatments,” said Dr. Daniel Leme, the study’s lead author and a postdoctoral scholar in Waterloo’s School of Public Health Sciences.
Off-Label Use of Antipsychotics
Antipsychotic medications are frequently prescribed in nursing homes for “off-label” uses, meaning they are administered for conditions not officially approved by health authorities such as the U.S. Food and Drug Administration (FDA). For instance, these drugs are sometimes used to manage behaviors linked to dementia, even though they are only FDA-approved for treating disorders like schizophrenia or certain forms of psychosis. A study revealed that between 2014 and 2020, 26% of nursing home residents in Canada were prescribed antipsychotics in ways not recommended by the FDA.
While antipsychotics are often employed to calm residents displaying aggressive or agitated behavior, their use comes with significant risks. Potential side effects include tremors, restlessness, muscle rigidity, painful contractions, and difficulty standing or walking. These adverse effects can worsen existing behavioral and psychological symptoms.
“Sometimes people may say they don’t have enough staff to deal with these issues, but the reality is that these medications can make disability and cognitive impairment worse,” said Dr. John Hirdes, a professor in the School of Public Health Sciences. “We need to seriously reconsider the use of antipsychotics for people who do not have conditions associated with psychosis.”
Behavioral and Psychological Symptoms of Dementia (BPSD)
The study outlines the inappropriate use of antipsychotics to treat behavioral and psychological symptoms of dementia (BPSD), which can include irritability, aggression, agitation, anxiety, depression, sleep or appetite changes, apathy, wandering, repetitive questioning, sexually inappropriate behaviors, and refusal of care.
Instead of turning to medication right away, researchers suggest focusing on person-centered care — getting to the root causes of a resident’s behavior and offering support in other ways. For example, a resident might need better pain management, clearer communication, or activities to help reduce anxiety. Non-drug therapies like music, art, social interaction, and gentle exercise have been shown to help manage behavior without the need for antipsychotics.
Training staff to understand the risks of antipsychotics and how to offer better care has also been linked to improved outcomes for nursing home residents, including less agitation and a better quality of life.
Reference: “A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care” by Daniel E.C. Leme, Krista Mathias, Amanda Mofina, Rosa Liperoti, Gustavo S. Betini and John P. Hirdes, 11 September 2024, Journal of the American Medical Directors Association.
DOI: 10.1016/j.jamda.2024.105255
The study is part of an international project called I-Care4Old, and was funded by the New Frontiers Research Fund Global Grant.
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26 Comments
Yeah, you don’t say…
Antipsychotics take away your nightmares… but they also take away your dreams and give you depression. It’s a losing proposition.
Drugging patients is easier than caring for them.
Not caring for the person is evil they don’t need antipsychotics I’m being abused by the system
Ketamine is showing wonderful results. It’s not for everybody of course, but it many cases it has been a real game changer. Especially for PTSD and resistant to treatment depression. I wish you all the best as a fellow sufferer. I’m looking forward to trying.
Oh please 😐 They give these drugs to the elderly in nursing homes so they will become “zombie like” and not be a bother.. My grandfather was given HALDOL for NO REASON.. My mom and some family went to visit him & questioned why he was the way he was. When they found out he was given Haldol, my mom & my cousin raised hell… I’m not so sure antipsychotics are even good to give to people with mental illness! Some of the side effects are horrific and make people feel worse, even suicidal… I guess SOME people benefit from psychiatric medications, but for the most part, they do no good and usually make people worse…. Mental health/mental illnesses in general needs to be completely reexamined and the mental health system (especially in America) needs a complete revamp… And the stigma that surrounds mental illness needs to disappear, especially the stigma and misunderstanding of BPD for one… Folks who have been diagnosed with these mental illnesses should actually have a bigger platform and people need to LISTEN.. as with every illness, not everyone has the same symptoms.. also, basing mental illness solely on textbook definitions does no good for anyone…just saying.
You want staff making $13 an hour to take care of 20 patients a piece that are angry and stuck in a home because they have no one that cares enough to take them on to their home. You want those staff to sit and listen abd love them when most people they knew abandoned them or dies on them, well you need to up the pay to about $30 an hour at least and increase the staff to about 1 in 6 patients them. No problem that’s about $20,000 increase in taxes for everyone. You got that money? No one will bother being practical and understanding of reality
Did this article come from the Onion?
“Scientists figure it out only after spending decades experimenting on and drugging patients for butt loads of cash”
You assume relatives are just to lazy and uncaring to take them in and that’s unfair. We can’t always care for our elderly parents. My MIL is in assisted living because we can’t take her in and she doesn’t want to move to a cold climate. (Not to mention we don’t have room) She is fortunate that she can afford a decent place.
You just wait…you have no clue what’s about to happen. Being completely alone is something we never expect to happen to us until it does. Don’t think it won’t happen to you.
Damn truth. ,
I took care of my Mom and dad til I was no longer able to pick my dad up when he would fall down . He was put on a medication for Alzheimer’s , he became a zombie.He started shuffling his feet while walking and stared off into space!!! I took him off of it ! He returned to the fun , joking , man that He had always been , He was put in to a great Veteran Home , I moved to be closer and went every other day as much as I could, My mom who was a full veteran also was going to move into the same place with her own apartment! As I was moving in to my new house she decided she would stay with me , Then she got sick a couple of months later. She went on Hospice but I took care of her til she died at home , and I went to see my dad regularly ! I made sure what drugs he was on and if I didn’t approve it they were not allowed to give him any unless I knew what and why ! He was happy where he was, he was able to get better care then I could give him and I believe he lived 10 years longer then he would have! But I was extremely vigilant about the medications they gave him! Drugging the elderly is an abuse ! And if you don’t like your job taking care of the elderly then get the Hell out of the job ! Cause if I ever caught you being mean to my daddy , I’d have kicked your butt !!! DO NOT WORK WITH OLD PEOPLE IF YOUR GONNA ***CH ABOUT IT. GO FLIP BUGERS OR DIG A DITCH! And pray I never see you abusing anyone or anything!!
Actually, you’re right, and that people that take care of elderly patients deserve to make more money. It’s a very hard job. Hard on your back and hard on your emotions. That being said. If all of these places were nonprofit, there would be much better care. Why should people make money off of other people being sick? I’m off for capitalism in goods and to a certain extent medication’s even but they need to be fairly priced. What cost $10 in Canada shouldn’t cost $500 in America. Why should someone get a check off of someone else’s hard work when it comes to the care of our most fragile in society? I know because they put up the money to start the business? The problem is they don’t run the business well. Every nursing home I’ve ever been to has been run short on staff to save a buck. You know what happens when they run short people die because there’s not enough help. My mother-in-law sat there dying, waiting to go to the hospital, but the nurse was out giving meds by the time she got back she was gone. Something happened nurses don’t just feel so bad that they pitch in and pay for the funeral. When you look and see a pair of slippers for $200 in the hospital. Catching them overbilling? The greed, it ruins everything. Capitalism is one thing, but when capitalism becomes so greedy that it’s ruining the medical industry as a whole something’s gotta give. Maybe profiting off of people getting cancer isn’t such a great thing. Look at Saint Jude that hospital look what they do all the good. The churches were the ones who started the hospitals. I know that’s idealistic to think that all things can be nonprofit but at some point, we as a society have to say OK either the consequences for blatant thievery are so severe that nobody wants to do it anymore. Or the government takes over and look what the government touches it’s never good. Maybe there’s a happy medium I don’t know. Maybe that’s why it hasn’t been fixed so far as there isn’t a happy medium is there? All I know is if you get caught over billing and being greedy you should face criminal charges so severe that you never see people taking that chance because it’s not worth it.
All truth. Thank you for saying it. Worked this job for many years for barely above minimum wage. I couldn’t afford anything. Lived with family. Spent all my time working. Feeling bad that I couldn’t care for people the way I would want to be cared for.
What most people don’t know is that the nursing home industry bleeds the individuals dry of their assets to the point of bankruptcy BEFORE medical insurance is ever applied. Most facilities are self pay only, with the average cost of a cot, not room starting at 3-4k a mo per person. Their clothing unless marked, are dumped in a general bin to be used for any client, unless the family takes care to independently wash them. Further, NAs are overburdened, underpaid and usually undertrained for the work they do. oftentimes the equipment they have per client is in stages of disrepair and patients are over medicated. How do I know this? As a person who grew up hiding my disability (cp) and at 19 ruined my back working in nursing homes. I have first hand experience and helped create the MiCasa Bill and Olmstead Act.
You are absolutely correct. Unfortunately I believe America is trending toward M.A.I.D. services like Canada. There are too few people who care and/or have the ability to change the system.
Haldol is NEVER given for no reason, there are so many hoops to jump through to even consider it.. there must have been an established pattern of prior behavior, and that’s behavior that happend AT the nursing home. There are several pharmacological and psychosocial interventions that are attempted BEFORE haldol is considered…
If you don’t like the care being provided, feel free to take care of them at home.
I am currently getting forcefully injected with antipsychotics, these drugs should be banned, especially haldol, although sometimes I think the pro antipsychotic people should get just one dose of it, that would shut them up,
Their commenting on the use of haldol on angry old people that are out of control. Well guess what, there’s nothing else but jail waiting for those people if you dont, with a lot of innocent patients that aren’t angry being the target of the patient receiving haldol. Some people have to be sedated and the response time for haldol is amazingly quick. There’s absolutely nothing wrong with using haldol in these situations until they come up with something that actually works.
You would not be saying that if you had a dose of it yourself.
When Medicine has become a capitalistic profiteering business and ignoring the true nature of medical practice the entire game becomes a Criminal Fraud.
Return Medicine to Honest Physicians and Purge the criminal parasite$ (Insurers lawyers mbas Wall Street)from Medical practice!!!
FIX THE CRIME!
Yes!
Amen
So, the meds they’re misusing for dementia patients are causing the behaviors we associate with dementia: from wandering to aggression. Great. Just great. Can we please ban psychology from, like, everywhere?
I was put on antipsychotics because I was grieving for my terminally ill husband. It was a GP who prescribed them, not a psychiatrist. Over the years I gained 200 pounds, lost my creativity so I don’t draw or paint anymore and if I try to stop them J get monstrous, unbearable depression. Yes, anti psychotics are being misused
Huh, who would have thought that people would act more civilly when they’re not feeling bored, lonely and useless. Surprised big pharma isn’t keeping their research classified. Probably cause it’s coming from Canada. God knows the US isn’t going to fund something like this, we’re too busy shooting ourselves up with drugs that make us skinny, swallowing pills that wake us up, pills to make us sleep, pills to counteract the side effects of other pills and using hormones to turn us into the opposite sex. Chasing it all down with a glass of more hormones because hormones, especially those found in birth control, cant be filtered out of waste water and ultimately end up in the drinking water. Smh God bless American Consumerism.