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Seniors get too many drugs, too little therapy: B.C. advocate

B.C. seniors are prescribed too many drugs that could cause harm and too few visits from therapists who could improve their lives, says a report from B.C.’s Office of the Seniors Advocate.
Isobel MacKenzie is B.C.'s seniors' advocate.

B.C. seniors are prescribed too many drugs that could cause harm and too few visits from therapists who could improve their lives, says a report from B.C.’s Office of the Seniors Advocate.

About one-third of seniors in care were prescribed anti-psychotic drugs but only four per cent were diagnosed with psychiatric illness, indicative of scenarios that continue to be “seriously wrong” in seniors’ care, said Isobel Mackenzie in her report, Placement, Drugs and Therapy … We Can Do Better, released on Tuesday.

“This is a clear indicator that these medications are being used to treat other, non-psychotic conditions, and are probably a tool to treat behaviour issues related to cognitive or mood disorders rather than actual psychotic disorders,” the report said.

The report, based on health assessment records from 25,000 seniors in residential care and 29,000 receiving home care, cites the overuse of drugs, lack of access to rehabilitative therapies and the premature admission of seniors to residential care as its top three issues.

Mackenzie noted that the use of anti-psychotic drugs has dropped from about 50 per cent in 2011, but said, “Clearly, there is more work to be done.”

The presence of side effects — which can include sedation, cognitive impairment, muscle and movement disorders — can also lead to misdiagnoses of dementia and Parkinson’s, resulting in even more wrongly prescribed drugs, the report says.

The widespread use reflects a long-standing convention by doctors, caregivers and families to look to medication when there are more progressive ways to deal with acting out, Mackenzie said.

“There’s arguably growing evidence to support maybe we don’t need to fix it,” she said. “The cure is worse than the disease.”

Research indicates strategies such as moving residents to single rooms, providing familiar caregivers and giving people time to do things at their own pace instead of rushing them can de-escalate agitation, she said.

Island Health spokeswoman Suzanne Germain said prescription drugs are “an ongoing challenge” at health authority facilities and efforts have been made to use them only when appropriate.

“We have implemented a number of initiatives to reduce the use of anti-psychotic drugs,” she said. “This includes education/training in managing the needs of residents with dementia and working with GPs, pharmacists and the interdisciplinary care team to reduce the use.”

Mackenzie also noted that between 1,500 and 4,400 B.C. seniors in long-term residences would be supported in their communities if they lived in other provinces.

“I am concerned about people being in residential care who don’t need to be there,” she said, adding that some might be able to return to the community if they got the amount of physical therapies given to seniors in other provinces.

Physiotherapy was among several “crucial” therapies received by only 11 per cent of B.C. residents in care compared with 25 per cent of Alberta seniors and almost 58 per cent of Ontario seniors, the report said.

Germain agreed that too many seniors have been inappropriately placed in long-term care, but said some were admitted many years ago under different criteria and would be supported at home today. Placements do not occur without the agreement of individuals or families, she added.

Health Minister Terry Lake said Mackenzie made “some interesting findings,” many of which are under discussion.

“We established the Office of the Seniors Advocate to identify issues that may be systemic and to work with the ministry to improve care for seniors in this province in a sustainable way.”

Improving care for seniors has been an ongoing priority for the government, said Lake, adding funding of home and community care has risen to $2.8 billion from $1.2 billion since 2001.

“Over the coming months, we will examine the data and findings in more detail as we continue to work to improve residential care in this province.”