Parkinson’s patients are over-prescribed antipsychotics

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Older adults in long-term care homes who have Parkinson’s disease (PD) are frequently prescribed antipsychotic medications without clear justification, according to a new study from the University of Waterloo and the Schlegel-UW Research Institute for Aging.

The study, published in the Journal of Parkinson’s Disease, found that doctors prescribed antipsychotics to more than one third, 34 per cent, of PD patients in long-term care (LTC) and almost one quarter, 24 per cent, of PD patients in complex continuing care facilities.

Antipsychotic medications can treat symptoms of dementia and other neuropsychiatric manifestations associated with PD, but guidelines suggest their use be reserved for those with severe agitation, aggression or psychosis, or those who are a risk to themselves or others.

“We found that antipsychotic prescribing among individuals living with Parkinson’s disease was far greater than that of severe aggression and psychosis combined,” said Dr. George Heckman, Schlegel Research Chair in Geriatric Medicine and a professor in the Faculty of Applied Health Sciences at Waterloo. “Given the risks associated with this kind of medication, which includes worsening mobility, falls, cognitive impairment, infections and mortality, the prescription of antipsychotics without strong justification of benefit is concerning.”

Physical restraints used on residents with Parkinson’s disease

The study also found that use of physical restraints was frequent among LTC residents  living with PD, particularly those who were male, disabled, cognitively impaired and incontinent.

“Our findings suggest that individuals with PD are not receiving optimal care and may be exposed to serious risks associated with antipsychotic and restraint use,” said Professor John Hirdes, of the School of Public Health and Health Systems and head of interRAI Canada. “Persons with PD are affected by a complex burden of issues, both from the disease itself and the health care system.”

While care practices were similar in homes across the country, the study points to the general need for better care for persons in continuing care settings. More frequent physician visits were associated with lower use of restraints or antipsychotic medications. Additional education and training for the health care team can also offer opportunities for better care.

Specialists with advanced training in geriatrics will improve care

“Increasing access to health-care professionals with advanced training in geriatrics is key to ensuring optimal outcomes for this disease,” said Hirdes. “We need a truly collaborative shared-care approach between primary care clinicians, specialists and inter-professional health providers. Understanding the complexities associated with aging should be a basic requirement for all health professionals.”

Parkinson’s disease is the second most common neurodegenerative disorder after Alzheimer’s disease. It affects more than 100,000 Canadians.

The study is part of the National Population Health Study of Neurological Conditions, and is one of the largest Canadian studies ever conducted on Parkinson’s disease.