Just over 50 per cent of elderly patients in British Columbia residential-care facilities were prescribed anti-psychotic drugs over a two-month period last year, according to a report commissioned by the provincial government.
And the most commonly used anti-psychotic drugs were “atypical” medications – drugs developed over the past few decades that have been linked to serious side effects, including strokes and heart attacks, and that Health Canada in 2005 said were not approved for use in elderly people with dementia.
“I had a fit when I read in [the report]that 50 per cent of patients are on anti-psychotics, some of them being the ones that are not supposed to be prescribed to old people,” Gloria Gutman, research associate with Simon Fraser University’s Gerontology Research Centre, said this week.
B.C. Health Minister Michael de Jong was not available for comment.
But in an e-mailed statement Thursday, his ministry said it was developing province-wide guidelines for the medications.
The pending guidelines will ensure consistent provincial standards for how and when to prescribe anti-psychotic medications and “will also address the use of atypical anti-psychotics, particularly in relation to the Health Canada warning for use in seniors,” the statement said.
The report – A Review of the Use of Anti-psychotic Drugs in B.C. Care Facilities – was quietly released in December and includes six recommendations, including “increased oversight” of medication practices. The province commissioned the study last year following media reports about a family who said their mother had been drugged without her own or family members’ consent.
Anti-psychotics were developed primarily to treat schizophrenia and bipolar disorder, but are increasingly being used to treat aggression and other symptoms of seniors’ dementia.
The use of atypical drugs noted in the report is part of the broader, complex issue of how to care for the increasing number of seniors with dementia who live in residential-care facilities, said Martha Donnelly, who heads the University of British Columbia’ geriatric psychiatry program.
With health authorities focusing on the cost-savings and health benefits of helping elderly people stay at home as long as possible, long-term care facilities are increasingly home to those with moderate to severe dementia.
“You have a very sick population in these facilities to deal with – and the staff have not necessarily had all the training that’s necessary,” Dr. Donnelly said. That problem is compounded by some older facilities that don’t have private rooms or secured outdoor space.
While saying there is a place for anti-psychotic drugs, even atypical ones, in long-term care settings, Dr. Donnelly said she’d like to see their use decline – but that it takes time, staff expertise and training to fully consider and implement the alternatives, and those are all in short supply.
Dr. Gutman also cited staffing issues as a factor in the high rate of anti-psychotic use.
“If you’re so short-staffed that all they can do is keep somebody dry and fed, they’re not going to have time to give the person-centred care,” she said, referring to an individualized approach.
The report does not address the rising use of anti-psychotic drugs, said Doreen Bodnar, who went public with her concerns about her mother, Hilda Penner, in 2011. Ms. Penner died last year.
The report found 50.3 per cent of seniors in long-term care facilities had been prescribed anti-psychotic drugs in the study period, compared with 37 per cent in 2001/02 and 47 per cent in 2006/07
But Ms. Bodnar is encouraged by the report’s recommendation that the ministry should educate doctors, facility staff and the public around the issue of consent.
“What was in our favour is that all of these people – doctors, nurses, whatever – they need to have consent to use a chemical restraint,” Ms. Bodnar said.
In preparing the report, researchers also heard concerns about staff safety. In a November bulletin on dementia and caregiver safety, WorkSafeBC said one in 10 long-term-care workers suffers a work-related injury each year; being hit, grabbed, bitten and kicked was second most-common cause of injuries. The first was over-exertion, usually from lifting.
An estimated 80 per cent of people in long-term care have dementia and the condition currently affects more than 70,000 people in B.C.