Antipsychotic use still out of whack in B.C., seniors advocate says
A quarter of people living in longterm care homes in B.C. are receiving antipsychotic medication without a supporting diagnosis, even though they have lower rates of psychiatric and mood disorders than their counterparts elsewhere in Canada, says the advocate for seniors.
Isobel Mackenzie said that while long-term care residents have slightly higher rates of dementia, their rates of moderate to severe dementia are lower than in other provinces, so the higher use of antipsychotics is troubling.
“They weren’t on an antipsychotic when they got to a care home and then we put them on an antipsychotic. Why?”
Staffing hours in B.C. are not related to the use of the drugs, Mackenzie said Thursday.
“There is no apparent clinical reason why our residents should be receiving more off-label antipsychotics than similar populations in other provinces. In fact, the clinical information supports that it should be less.”
Antipsychotic medication, which is more powerful than antidepressants, is typically prescribed “off label” to treat dementia, schizophrenia and other forms of psychosis, but it is not approved to treat those conditions.
Mackenzie said that in the past five years, B.C. has reduced the use of antipsychotics by 22 per cent for undiagnosed seniors, but it hasn’t made any gains in the past year.
Alberta, Manitoba and Ontario have done better in decreasing misuse of the drugs and it’s time for B.C. to take more action, she said of data collected from the provinces by the Canadian Institute for Health Information.
“The gains we were making were not as significant as those provinces were making, which were starting already from a place of lower prescribing,” Mackenzie said.
Ontario’s rate of prescribing antipsychotics to seniors in longterm care has dropped by more than a third in the past three years, the institute says.
Mackenzie said many seniors are heavy users of multiple medications, but as a group are typically excluded from clinical trials.
Elderly people in care homes may not even be capable of providing consent for medications and what may be side-effects, including confusion and fatigue, may be wrongly attributed to aging, she said. However, both prescribing doctors and family members may consider antipsychotics, which can have serious side-effects, an answer to non-psychosis issues, Mackenzie said.
“There will be family members who say, ‘My mom’s agitated, do something about it.’ Pressure, pressure, pressure.”
Many residents in care homes would be better off with an adequate assisted-living program and provincial rent subsidies, Mackenzie said.
Leslie Remund, executive director of the 411 Seniors Centre Society, said care homes are a cheaper alternative. She said better rental policies for seniors would save the government money, but a recent raise in a shelter aid program for elderly renters doesn’t provide enough money in high-priced markets.