A recent report
by the Canadian Institute for Health Information
(CIHI) found that seniors in long-term care homes take twice the number of medications than those seniors who still live at home. Seniors in long-term care facilities are also twice as likely to be prescribed opioids as compared to other seniors. The report, which used 2016 data and involved seniors from across Canada, examined drug use by seniors (those aged 65+) in both long-term care and living at home, focused on:
- The number of drugs prescribed to seniors;
- Drug classes most commonly prescribed to seniors;
- Potentially inappropriate prescribing to seniors;
- Prescribing to seniors in long-term care facilities.
Number of Drugs Prescribed to Seniors
That report found 25% of seniors take at least ten prescription drugs. This number increases 75% of seniors who live in long-term care facilities.
Drug Classes Most Commonly Prescribed to Seniors
Commonly prescribed drugs for such seniors include high cholesterol drugs (used by almost half of all seniors), acid reflux drugs, peptic ulcer drugs, high blood pressure drugs, and anxiety medication. Seniors who are prescribed ten or more drugs were five times more likely than seniors who were prescribed fewer drugs. Cancer drugs, opioids, and blood thinners are the most common drug categories which led to adverse reactions and hospitalizations.
The report found that almost 2 million Canadian seniors chronically used at least one potentially inappropriate drug in 2016. Drugs used for acid reflux disease (e.g. proton pump inhibitors) and benzodiazepines (for anxiety and insomnia) are some of the drugs that can be considered potentially inappropriate. Use of potentially inappropriate drugs is a concern as it can increase the risk of adverse effects, including mental impairment and falls.
Seniors in Long Term Care
As noted above, the study found that seniors in long-term care use more drugs than those who still live at home. This can be attributed to the fact that seniors in long-term care tend to be older, more frail, and sicker than seniors living in the community. In addition to generally using more drugs, seniors in long-term care facilities are also twice as likely to be prescribed opioids as compared to other seniors, and are three times more likely to be on antidepressants. Approximately 40% of long-term care residents in Ontario, Manitoba, B.C., New Brunswick, and P.E.I. are prescribed opiates, compares to 20.4% of all seniors. Approximately 60% of all long-term care residents were on antidepressants, compared to 19.1% of all seniors.
Other Notable Findings
Some of the report’s other findings included:
- Women had a higher chronic use of potentially inappropriate drugs as compared to men (36.8% for women as compared to 29.8% for men);
- Seniors living in low-income or rural/remote neighbourhoods were prescribed more drugs;
- Older seniors (85+) used a higher number of drugs;
- There was a decline in the use of antipsychotics (for bipolar disorder and schizophrenia) and benzodiazepines (for anxiety and insomnia) in long-term care facilities.
Although seniors make up only 17% of the Canadian population, they account for about 40% of all spending on prescribed drugs, and 55% of public drug program spending. Concurrently, the senior demographic is growing faster than any other population in Canada. Seniors use more drugs than any other age group, on average, largely due to their predisposition to have a higher number of chronic conditions. The use of multiple drugs is associated with a higher rate of potentially inappropriate drug use and a higher chance of adverse drug events. Seniors are also more at risk for adverse drug-events due to the higher amount of drugs they are taking, and due to age-related physical changes. The report concluded that the need to reduce the number and type of drugs being prescribed for seniors is a topic of increasing concern among practitioners and organizations nation-wide. A number of studies address the importance of deprescribing among elderly patients, particularly at the end of life. This report may serve to be of interest to operators of long-term care facilities
as well as regulated health professionals
who regularly treat seniors. At Wise Health Law
, we provide exceptional guidance on health law matters to public hospitals, long-term care homes, and other health-care providers across the province. We monitor trends and developments in the health sector so that we can provide consistently forward-thinking legal advice and risk management guidance to all of our clients. We have offices in both Toronto and Oakville, Ontario, and are easily accessible. Contact us online
, or at 416-915-4234
for a consultation.