Drugging seniors still too prevalent, advocate says

Too many seniors in residential facilities are still being given antipsychotic drugs, warns B.C. seniors advocate Isobel MacKenzie in response to a national report.

Despite known health risks of antipsychotics, 39 per cent of residents in long-term care in Canada were prescribed an antipsychotic at least once in 2014, says the report by the Canadian Institute for Health Information.

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“We used to heavily drug people in our mental health facilities,” Mackenzie said. “And I think 20 years from now we will have the same reaction for what we are doing for our seniors in residential care.”

Antipsychotics are often prescribed to seniors to treat symptoms of dementia, such as aggression and agitation, as well as schizophrenia and other psychosis, but most can have harmful side effects including a sudden drop in blood pressure, falls, fractures, strokes and death.

Residents with severe cognitive impairment and those exhibiting highly aggressive behaviour were more likely to have used an antipsychotic, the report said.

Alan Cassels, a University of Victoria researcher, said people in long-term care facilities are well aware that antipsychotics are over-prescribed. However, the fallback to dealing with problematic residents is to “zombify them,” especially in facilities with insufficient staffing.

Risperidone is the only antipsychotic approved for use in the treatment of symptoms of dementia in Canada. However, the CIHI report said guidelines include the use of other antipsychotics, noting that Quetiapine is the most commonly used antipsychotic.

The report also noted that, even in cases of severe aggression, only about half of all cases involved the use of antipsychotic drugs, which suggests that non-drug alternatives were often considered.

“You don’t have to be drugging these people, you can use more humane, human-centred ways of dealing with them,” Cassels said.

“If it was my mother, I would say [to health-care providers] I want you to try all non-drug options first because we know these drugs are toxic, we know that they turn people into zombies, and we don’t want our loved ones to spend their last years in a drug-induced haze,” Cassels said.

The report shows that, from 2006 to 2014, the rate of antipsychotic use by seniors in residential care in B.C. has remained steady at about 48 per cent with only the slightest reduction in recent years.

Cassels said the report doesn’t say anything new and that’s the problem — very little is changing.

“There is a warning that these drugs will increase the risk of death in people with dementia and yet we still have this outrageous level of prescribing,” Cassels said.

There is some good news. Manitoba, for example, recorded a reduction in the use of antipsychotics from 31.5 to 38.2 per cent from 2006 to 2014.

Credit was given to a program adopted by the Winnipeg health authority encouraging facility staff to use creative solutions rather than medication.

Closer to home, Island Health says potentially inappropriate use of antipsychotic medication has dropped to 33.5 per cent in 2014 from 39.3 per cent in 2010.

In 2012, the B.C. Health Ministry developed a province-wide guideline for antipsychotic drug use in residential care facilities, spokeswoman Sarah Plank said, noting that the ministry, health authorities and care facilities have taken steps to reduce reliance on antipsychotic medications in residential care.

“We need to better respect who they are as individuals rather than requiring homogenized behaviours from people in residential care,” MacKenzie said, adding more trained-staff are needed.

“I think we are just increasingly seeing our moms and dads and potentially ourselves in residential care and that’s why people are speaking up more.”


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