There is no shortage of reports on how to improve the system of residential care for our seniors.
The latest one, released last month, titled Placement, Drugs and Therapy. .. We Can Do Better, comes to us courtesy of B.C. seniors advocate Isobel Mackenzie. The report's findings about a lack of access to rehabilitation therapies for seniors in care and the premature admission of seniors to residential care are noteworthy but it was the news that too many seniors get the wrong drugs that garnered most of the headlines.
The issue of over medicating seniors isn't really new. In 2011, elder law expert Laura Watt called the use of antipsychotic drugs for people with dementia a national epidemic.
Mackenzie found that about one-third of seniors in residential care in B.C. are on antipsychotic medication but only four per cent have a diagnosed psychiatric condition.
If you've visited a longterm care facility in B.C. and wondered why so many of the residents appeared to be in a drug-like stupor, it's because they potentially were. Antipsychotics were developed primarily to treat schizophrenia and bipolar disorder, but are increasingly being used to "calm" the behaviour of seniors with dementia.
"It is well known," says Mackenzie in the report, "that antipsychotic drugs are sometimes used to manage aggressive behaviours in residents who have dementia. This was not what they were intended to treat, nor are there robust clinical trials involving frail seniors to properly monitor the side effects."
Getting your meds right is an essential part of keeping most seniors healthy. But Mackenzie found that while almost half of residential care clients are being prescribed antidepressant medications, only 24 per cent of those clients have actually been assessed as having depressions.
"This is a sizeable gap between diagnosis and prescription," said Mackenzie in a news release. "We should be asking serious questions, given the side effects of these drugs, as to whether they are the most appropriate for seniors in question."
Those side effects include strokes and heart attacks, prompting Health Canada and the Food and Drug Administration in the United States to warn us a decade ago that antipsychotic drugs were not approved for use in elderly patients with dementia.
There are facilities here and abroad that have dramatically reduced the use of antipsychotic drugs prescribed to persons with dementia in their care. Their secret? Better staffing levels. Facilities that have more staff and, in particular, specialized staff, like recreation and music therapists, are likely to have less need to use drugs to sedate patients. Of course, there is a cost to hiring extra staff. It's quicker, easier and cheaper to give a patient an extra pill.
Those decisions are now coming back to haunt us. Mackenzie would like to see more education for physicians and care providers on drug use in care facilities. I'd take it one step further. If the use of antipsychotic drugs as a chemical restraint on dementia patients isn't already against the law it should be. Working with clients who were in care in B.C., I've come to believe that the environment in which you live can be as disabling as a disease. When it becomes our practice to sedate thousands of seniors in care with antipsychotic drugs, in lieu of providing good care, there's not just a problem with the system, there's a problem with us. Every once in a while we need to tell those we have entrusted to run our healthcare system that what they're doing is wrong. This is one of those occasions.
Tom Carney is the former executive director of the Lionsview Seniors’ Planning Society. Ideas for future columns are welcome. He can be reached via email at [email protected].
