The huge variance in the rates and ways antipsychotic are prescribed to elderly people with dementia around the world and the strong push to discourage and decrease their use are proof there are better ways to help people with dementia live well until they die.
I’ve blogged about the United Kingdom’s success in quickly reducing the use of antipsychotics; here’s an excerpt:
In June 2012 the UK’s National Dementia and Antipyschotic Prescribing Audit Summary Report showed that while the number of newly diagnosed people with dementia increased by almost 68 per cent between 2006 and 2011, there was a 60 per cent decrease in the number of people with dementia receiving prescriptions of antipsychotic medication (i.e. to 7 per cent in 2011 from about 17 per cent in 2006) .
In contrast, the rate of prescription of antipsychotics to the elderly has remained virtually the same (i.e. between 300 and 600 prescriptions per 1,000 elderly people) in nine of Canada’s 10 provinces over a similar period (2009 – 2014) .
Shockingly, in Quebec, the province in which I live, the rate of prescribing antipsychotics to the elderly was 1,314 prescriptions per 1,000 in 2014. That’s 1.3 prescriptions per elder — four times the prescribing rate in Alberta and Newfoundland, double the rate in Ontario and New Brunswick. Antipsychotics are designed to help people with schizophrenia, which occurs at a rate of about one to two per cent in populations overall. What’s wrong with this picture?
AND, while the UK reduced the number of antipsychotic prescriptions to the elderly by 52 per cent from 2008 to 2011, the rate of prescribing antipsychotics to the elderly INCREASED by 20 per cent in Quebec from 2009 to 2011. Overall, it rose by 31 per cent between 2009 and 2014. Hmmmmm.
Furthermore according to the 2015 Ontario Drug Policy Network report:
- Prescriptions for antipsychotics to elderly patients in Canada increased nearly 32 per cent between 2009 and 2014, to about 4 million prescription from about 3 million . (Download the 2015 Ontario Drug Policy Network report here.)
- The total amount spent on antipsychotic prescriptions dispensed to elderly patients in Canada increased by 21 per cent to $75 million between 2009 and 2014. As the rates in the other nine provinces remained relatively flat, Quebec is likely responsible for the lion’s share of the cost increase.
- The bulk (97 per cent) of antipsychotics prescribed in Canada are atypical antipsychotics such as quetiapine and risperdone.
Are there twice as many crazy old people per thousand in Quebec than there are in Ontario? Are Quebec seniors with dementia four times more likely to require medication than those in Alberta? And if so why? Why do rates of prescription vary so dramatically between provinces, regions and countries? Why do some places resist change and continue to prescribe drugs “off label” to old people with dementia knowing full well the risks include an earlier death? Why are some places, provinces, regions and countries committed to change and others seem to be in denial about moving forward?
Lots of questions. I continue to explore answers.