B.C.’s seniors advocate is continuing to voice concern about high rates of anti-psychotic drug use among seniors living in care homes.
Provincial seniors advocate Isobel Mackenzie commented on the issue following her latest report on almost 300 publicly funded care homes in the province, released at the end of last month.
Residents in many of those care homes, including those on the North Shore, had high rates of anti-psychotic drug use even though they had not been diagnosed with psychosis.
“It’s a question of degree. There’s too much off-label use of anti-psychotics and also anti-depressants happening in our care facilities,” said Mackenzie.
Lynn Valley Care Centre, a 204-bed seniors care home in North Vancouver, had the third highest rate of anti-psychotic use in the province, according to the report, with 51 per cent of residents taking anti-psychotic medication without a formal diagnosis.
At one “special care” 12-bed unit where seniors are stabilized and assessed at Kiwanis Care Home, 77 per cent of residents were taking the drugs.
Rates of “off-label” use of anti-psychotic drugs at most other North Shore seniors’ care homes were lower, ranging from 38 per cent at Kiwanis Care Home generally to over 34 per cent at Evergreen Extended Care at Lions Gate Hospital, 31 per cent at Inglewood Care Home in West Vancouver, and 28 per cent at the West Vancouver Care Centre.
All but one of those rates is above the B.C. average of 29 per cent of anti-psychotic use in care homes, which itself is higher than the rest of Canada.
“We’re seeing less misuse of medications than we used to in the past. We’re still seeing more than we should be seeing,” said Mackenzie.
Mackenzie said seniors in care homes are often prescribed anti-psychotic medication “off label” if they are showing symptoms like agitation, which is often associated with dementia. Sometimes doctors and care home staff worry about safety and sometimes families find the behaviour disturbing, said Mackenzie.
Drugs can be used as a quick fix. “They dull you. They make you docile,” she said.
But using drugs to control behaviours is also potentially dangerous, she said, because the drugs have not been tested for that purpose and have not been tested on the elderly.
“There is a danger,” she said. “They are very powerful drugs.” There is a relationship between taking the drugs and earlier death, she said.
Mackenzie said there is also a clear connection between elderly people moving into a care facility and being put on the drugs.
According to provincial pharmacy figures, 32 per cent of care home residents with no history of taking anti-psychotics before they went into an institution were prescribed that drug within six months, she said, the majority within a week. “That’s a big number,” she added.
In contrast, only about 13 per cent of the elderly receiving home care in the community are on anti-psychotic drugs, she said and the number is much lower among the general population of seniors.
“We know there are better ways to work with somebody who’s in an agitated state,” she said, including early interventions. But “Those things require the staff to do it … and be appropriately trained and it requires a culture in the facility that supports these alternatives to pharmacological intervention.”
Lynn Valley Care Centre’s director of care, Leslie Cymet, said staff and administrators are examining the issue.
Vancouver Coastal Health spokeswoman Anna Marie D’Angelo said health officials are talking to administrators at Lynn Valley Care Centre about why the rate of anti-psychotic use is so high there.
She said the health authority acknowledges, “There is a need to reduce inappropriate use of antipsychotic medications in residential care.”
