Care homes in B.C. are giving antipsychotic medications to too many seniors who haven't been diagnosed with psychosis, and that may be responsible for aggression and injuries among the elderly, according to the province's seniors advocate.
In facilities across the province, an average of 27 per cent of residents are taking antipsychotics without a matching psychiatric diagnosis, according to the newly updated Residential Care Facilities Quick Facts Directory.
The average percentage has declined in recent years, but B.C. Seniors Advocate Isobel Mackenzie says it's not happening as quickly as it has in other provinces.
“It’s a problem everywhere, but for some reason it is worse in B.C.,” she said.
There are three care homes in B.C. where more than half of residents were taking antipsychotics without a diagnosis of psychosis in 2015-16: Youville Residence (62.6 per cent of residents) and Adanac Park Lodge (52.1 per cent) in Vancouver, and Lynn Valley Care Centre (51.1 per cent) in North Vancouver.
Mackenzie doesn't subscribe to the theory that care home staff are using antipsychotics to make their charges easier to control. She believes doctors prescribe these medications because they're trying to control certain symptoms, but the drugs may do more harm than good.
“You will find more aggressive behaviours with higher antipsychotic use,” she said. “There was a brilliant study done in Manitoba: You take them off the antipsychotics, the incidents of aggression went down.”
A lot of these drugs aren’t tested on the elderly either, so care home residents may experience side effects in unexpected ways, which could lead to further problems.
“You give somebody an antipsychotic to treat something that you think is an agitation, you exacerbate the delirium and things get worse. They get drowsy, they trip, they fall,” Mackenzie said.
In B.C., the advocate’s office hasn’t found a clear predictive pattern linking high levels of antipsychotic use to seniors attacking other care home residents, but certain numbers in the care facilities directory are compelling nonetheless.
The directory includes reports of incidents in care homes across the province, including things like aggression between patients, injuries, abuse and neglect, and falls. Some facilities have consistently high rates across a number of different categories.
One of these is Stuart Nechako Manor, a 53-bed facility in Vanderhoof operated by Northern Health. It has B.C.’s highest rates for aggression between residents and injuries caused by something other than a fall, as well as the fourth highest rates for falls causing injury and abuse/neglect.
At the home, 47.6 per cent of residents are taking antipsychotics without a psychosis diagnosis.
Mackenzie said she didn’t know enough about Stuart Nechako Manor to explain the high rates of certain events. Still, she suggested looking into the high rate of antipsychotic use.
“Could you reduce the aggression between persons in care where they re clearly higher? Would you reduce those falls with injury?” she said.
According to Andrea Palmer, a spokeswoman for Northern Health, many of the issues identified at Stuart Nechako Manor have been addressed as part of a licensing review.
“The incidents have all been investigated and a number of measures have been put in place that include additional training and orientation for staff; ongoing assessment and review of residents to identify needs and best placement options to co-locate residents into care areas/pods designed to best meet their needs; and implementation of procedures and protocols for managing inappropriate interactions between residents,” Palmer said.
She was unable to specifically address the facility s antipsychotic drug rates by deadline.
Of course, there are valid reasons for administering these medications without a proper diagnosis. Some facilities have units that strictly handle people who are experiencing aggression or delirium linked to their dementia, and they ll be given antipsychotic drugs to stabilize them before they are sent to live elsewhere.
One of those is the Youville Residence, where two of the facility s four floors are designated to the Parkview Unit, an acute-care centre that treats patients with extreme behaviour issues on a temporary basis, according to the operator, Providence Health Care.
“Many times these are people who have been on the front page of your newspaper with resident-to-resident aggression and such,” said Jo-Ann Tait, Providence s director for elder care and palliative services.
The health-care provider is currently working on teasing out the data for the residential floors at Youville, and Tait is confident the antipsychotic rates will fall to the provincial average or below.