Changes in drug prescribing to seniors in Canada

October 20, 2022 — Take an in-depth look at drugs prescribed to seniors (those age 65 and older) in Canada. On average, seniors have a higher number of chronic conditions and as a result are prescribed more drugs than other age groups.Reference1,Reference2 The use of multiple drugs is associated with a higher risk of emergency department (ED) visits and hospitalization due to adverse drug events.Reference3,Reference4

The Drug Use Among Seniors in Canada, 2021 data tables contain results from 2017 to 2021 on the total number and types of drugs most commonly prescribed to seniors in Canada. They also provide results focused on seniors living in long-term care (LTC) facilities. A summary of the key findings, including changes in prescribing due to COVID-19, is presented below.

The drug claims data comes from CIHI’s National Prescription Drug Utilization Information System (NPDUIS), as submitted by public drug programs in all Canadian provinces and Yukon. Data on drugs prescribed to seniors in LTC facilities is available through LTC-specific public drug programs in Newfoundland and Labrador, Prince Edward Island, New Brunswick, Ontario, Manitoba and British Columbia. As there are differences in public drug program coverage and socio-demographic factors across jurisdictions, please consider public drug program design when comparing results across populations. 

1 in 4 seniors were prescribed 10 or more unique drug classes in 2021. (A drug class is a group of different chemicals that work in the same way and are often used to treat similar medical conditions.) On average, female seniors were prescribed more drugs than their male counterparts, and the average number of drugs prescribed increased with age. Also, seniors living in lower-income neighbourhoods were prescribed more drugs compared with those in higher-income neighbourhoods. In general, people with lower incomes experience poorer overall health and have a higher number of chronic health conditions.Reference5

Percentage of seniors prescribed 10 or more drug classes, 2021

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Population	Percentage of beneficiaries prescribed 10 or more drug classes
Females	24.6%
Males	23.3%
Age 65 to 74	18.2%
Age 75 to 84	28.1%
Age 85+	36.4%
Urban*	20.7%
Rural/remote*	20.7%
Lowest income quintile*	25.5%
Highest income quintile*	16.5%

Notes
* Excludes data from Quebec.
The Northwest Territories and Nunavut do not currently submit data to NPDUIS. The federal program administered by the First Nations and Inuit Health Branch (FNIHB) has been excluded because data was not available after 2019.

Sources
National Prescription Drug Utilization Information System, 2021, Canadian Institute for Health Information; Banque médicaments, 2021, Régie de l’assurance maladie du Québec.

Drugs to treat cardiovascular conditions (including high cholesterol, high blood pressure, heart failure and angina) were the most common drug classes prescribed to seniors and made up 5 of the 7 top drug classes in 2021. Furthermore, over half of seniors were prescribed statins, which are commonly used to treat high cholesterol and are prescribed after a heart attack.Reference6

Drugs to treat diabetes saw the largest increase in utilization. Use of drugs to treat diabetes increased from 20.1% in 2017 to 21.4% in 2021, representing approximately an additional 220,000 seniors. The majority of this increase is due to increased prescribing of sodium–glucose co-transporter 2 (SGLT-2) inhibitors — a class of diabetes medications that helps reduce glucose levels in the body by increasing the amount of sugar excreted through the urine.Reference7 SGLT-2 inhibitors have been found to decrease the risk of hospitalization due to heart failure and the progression of chronic kidney disease.Reference8 Clinical prescribing guidelines updated in 2020 included expanded recommendations for prescribing SGLT-2 inhibitors.Reference9

There was decreased utilization of opioids among seniors, declining from 17.3% in 2017 to 14.9% in 2021. This represents approximately 32,000 fewer seniors. The Canadian Guideline for Opioids for Chronic Non-Cancer Pain, released in 2017, provides recommendations for the safe prescribing of opioids which may contribute to this decrease.Reference10

Note
The Northwest Territories and Nunavut do not currently submit data to NPDUIS. The federal program administered by the First Nations and Inuit Health Branch (FNIHB) has been excluded because data was not available after 2019.

Sources
National Prescription Drug Utilization Information System, 2017 to 2021, Canadian Institute for Health Information; Banque médicaments, 2017 to 2021, Régie de l’assurance maladie du Québec.

During the pandemic, policy changes and safety measures introduced due to COVID-19 resulted in people having fewer interactions with the health care system.Reference11 This has resulted in fewer physician visits, hospital services, ED visits and surgeries.Reference11 Consistent with seniors having fewer interactions with the health care system, there has been a decrease in the average number of drugs prescribed to seniors.

However, the use of drugs to treat chronic conditions has remained stable during the pandemic. This suggests that while overall health care utilization may have declined because of the pandemic, drugs required to treat chronic conditions continued to be prescribed to seniors during this time. These findings were seen in both females and males, in all age groups, in seniors living in urban and rural/remote neighbourhoods and in all neighbourhoods regardless of average neighbourhood income. (Chronic use of drugs is defined as someone having multiple claims and at least 180 days supply in a year.)

Note
The Northwest Territories and Nunavut do not currently submit data to NPDUIS. The federal program administered by the First Nations and Inuit Health Branch (FNIHB) has been excluded because data was not available after 2019.

Sources
National Prescription Drug Utilization Information System, 2017 to 2021, Canadian Institute for Health Information; Banque médicaments, 2017 to 2021, Régie de l’assurance maladie du Québec.

From 2020 to 2021, growth in the prescribing of antidepressants was larger than in previous years. Use of antidepressants among seniors reached 23.4% in 2021, compared with 22.3% in 2019. This represents approximately 140,000 more seniors prescribed antidepressants since the beginning of the pandemic. Studies show that rates of depression and anxiety in Canada have increased during the COVID-19 pandemic.Reference12

Prescribing of antibiotics has decreased significantly since the beginning of the pandemic, from 38.6% prior to the pandemic to 30.5% in 2021. This change represents 380,000 fewer seniors. The decrease may be due to reduced access to physicians during the pandemic, or to people seeking care only when more severe symptoms are present.Reference13 The prescribing of fewer antibiotics is essential to slow the emergence of antimicrobial resistance (AMR) — a serious and growing global public health threat.Reference14 However, the shift to virtual care may lead to more diagnostic uncertainty compared with diagnoses during a physical examination, which may increase inappropriate prescribing of antibiotics and AMR.Reference13

Note
The Northwest Territories and Nunavut do not currently submit data to NPDUIS. The federal program administered by the First Nations and Inuit Health Branch (FNIHB) has been excluded because data was not available after 2019.

Sources
National Prescription Drug Utilization Information System, 2017 to 2021, Canadian Institute for Health Information; Banque médicaments, 2017 to 2021, Régie de l’assurance maladie du Québec.

The COVID-19 pandemic has disproportionately affected LTC facilities and retirement homes in Canada.Reference15 Lengthy lockdowns have been imposed in LTC settings, resulting in concerns about the mental health of the residents and increased use of psychotropic medications.Reference16

Seniors living in LTC facilities are prescribed more drugs compared with seniors living in the community.Reference17 This is also true when looking at the use of selected psychotropic drugs (antidepressants, benzodiazepines and antipsychotics). In 2021, seniors living in a LTC setting were 3 times more likely to be prescribed an antidepressant or benzodiazepine, and 8 times more likely to be prescribed an antipsychotic.

During the pandemic, the prescribing of psychotropic drugs increased more among seniors living in LTC compared with seniors living in the community. Among those in LTC, the use of antidepressants increased from 62.0% in 2019 to 64.7% in 2021, while the use of antipsychotics increased from 37.1% to 42.5% during the same period.

Restrictions on LTC admission during the pandemic resulted in a decrease in the number of LTC residents.Reference15 This change in the overall LTC population should be considered when examining trends in drug prescribing in LTC. 

Psychotropic drug use in LTC, 2017 TO 2021

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Drug class	2017	2018	2019	2020	2021
Antidepressants	60.8%	61.5%	62.0%	63.3%	64.7%
Antipsychotics	36.2%	36.7%	37.1%	39.9%	42.5%
Benzodiazepines	25.2%	24.3%	23.6%	24.0%	23.5%

Notes
There were 6 provinces submitting identifiable LTC data to NPDUIS as of November 2021: Newfoundland and Labrador, Prince Edward Island, New Brunswick, Ontario, Manitoba and British Columbia. 
LTC data from Newfoundland and Labrador is not available prior to March 2017.

Source
National Prescription Drug Utilization Information System, 2017 to 2021, Canadian Institute for Health Information.

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