Too many drugs for seniors

Too many drugs are being administered to seniors in care facilities, but it appears that things are beginning to change. B.C. seniors advocate Isobel Mackenzie released a report last week on residential-care facilities, and once again, she flagged the use of antipsychotic and antidepressant medications as a problem.

She found that 25 per cent of carehome residents took antipsychotics without a diagnosis of psychosis in 2016-17. Fortunately, that is down from 31 per cent in 2014-15. But the number is still worrying, particularly because, as in past years, B.C. has one of the highest rates of antipsychotic use without a diagnosis of psychosis, Mackenzie said.

Antipsychotics are connected to increased risk of falls, confusion and death.

At the same time, 48 per cent of residents were on antidepressants, even though only 24 per cent had been diagnosed with depression. Anti-depressants can produce fatigue, confusion and lethargy, which can be mistaken as symptoms of dementia.

Families and those who are getting close to needing long-term care have to be concerned about those figures. And why are the numbers so high?

It’s hard to avoid making a connection to other figures in Mackenzie’s report: Only 15 per cent of care homes were meeting the provincial guideline of 3.36 hours of direct care per resident per day in 2016-17. Even though the number is up from nine per cent the year before, those are dismal figures.

Are we substituting pills for the human contact that lonely residents need?

The fact that so many are being prescribed powerful medication without a related diagnosis is cause for concern, no matter what the rationale. That’s why many families are agitating against the use of antipsychotics, in particular.

Complicating the issue is the fact that the medications serve another purpose: patient safety.

The proportion of care-home residents with dementia is increasing; it’s at 63 per cent in B.C. With dementia can come unpredictable and sometimes aggressive behaviour. That aggression is often directed at other residents. Antipsychotics can help reduce the problem.

The CBC looked into care homes in Ontario and found that as facilities reduced the use of antipsychotics in recent years in response to family concerns, incidents of abuse between residents went up. In Ontario, the number of reported cases of residenton-resident abuse went from 1,580 in 2011 to 3,238 in 2016, even though the number of residents rose by only a small percentage.

No such pattern is evident in B.C., where incidents totalled 493 in 2014/15, dipped to 418 in 2015/16 and rose to 488 in 2016/17.

In a report in 2016, Mackenzie’s office looked at resident-on-resident aggression. The report recommended better training for staff in dealing with aggressive behaviour and design changes to facilities that help reduce incidents and limit residents’ ability to wander, which can lead to conflict.

Researchers say as the number of dementia patients increases, existing staffing levels aren’t sufficient to manage the more frequent behavioral problems.

The province has 110 facilities that are operated by a health authority and 183 that are operated by a contractor with funding from health authorities. A report last year said it would cost $113 million a year to bring all those facilities up to the guideline of 3.36 hours of direct care.

The province plans to put $500 million into the system over the next four years.

Better facility design, more staff and more training are better than more drugs.