VANCOUVER – A quarter of people living in long-term care homes in British Columbia are receiving antipsychotic medication without a supporting diagnosis even though they have lower rates of psychiatric and mood disorders compared with their counterparts elsewhere in Canada, says the province’s advocate for seniors.
Isobel Mackenzie said that while long-term care residents in the province have slightly higher rates of dementia their rates of moderate to severe dementia are lower in comparison so the higher use of antipsychotics is troubling.
“They weren’t on an antipsychotics when they got to a care home and then we put them on an antipsychotic. Why?”
Staffing hours in B.C. are not related to the use of the drugs, Mackenzie said Thursday.
“There is no apparent clinical reason why our residents should be receiving more off label antipsychotics than similar populations in other provinces. In fact, the clinical information supports that it should be less.”
Antipsychotic medication, which is more powerful than antidepressants, is typically prescribed “off label” to treat dementia, schizophrenia and other forms of psychosis but it is not approved to treat those conditions.
Mackenzie said that in the last five years, B.C. has managed to reduce the use of antipsychotics by 22 per cent for undiagnosed seniors but it hasn’t made any gains in the last year.
Alberta, Manitoba and Ontario have done better in decreasing misuse of the drugs and it’s time for B.C. to take more action, she said of data collected from the provinces by the Canadian Institute for Health Information.
“The gains we were making were not as significant as those provinces were making, which were starting already from a place of lower prescribing,” Mackenzie said.
Ontario’s rate of prescribing antipsychotics to seniors in long-term care was 30.5 per cent in 2013-14, but decreased by 35.6 per cent in 2017-18, the institute says.
Mackenzie said many seniors are heavy users of multiple medications but as a group are typically excluded from clinical trials.
Elderly people in care homes may not even be capable of providing consent for medications and what may be side effects, including confusion and fatigue, may be wrongly attributed to aging, she said.
However, both prescribing doctors and family members may consider antipsychotics, which can have serious side effects, an answer to non-psychosis issues, Mackenzie said.
“There will be family members who say, ‘My mom’s agitated, do something about it.’ Pressure, pressure, pressure.”
Many residents in care homes would be better off with an adequate assisted-living program and provincial rent subsidies, Mackenzie said.
Leslie Remund, executive director of the 411 Seniors Centre Society, said care homes are a cheaper alternative. But she said better rental policies for seniors would save the government money and a recent raise in a shelter aid program for elderly renters doesn’t provide enough money in high-priced markets.
“We saw about 1,800 individuals last year and one third of those people came to us for housing needs, both precariously housed, at risk of losing their housing or absolute homelessness.”
Other data from the Canadian Institute for Health Information says long-term care homes in B.C. appear to be healthier than the national average, with lower rates of depression, arthritis and heart and circulatory disease.
The agency says B.C. seniors in home care are less frail than those in other provinces but are 16 per cent more likely to have limited or no social engagement compared with the national average.
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