Seniors in care drugged with antipsychotics to much higher degree in B.C. than in Alberta and Ontario

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      Grace Hann has a long list of concerns about the challenges facing seniors in B.C., ranging from their housing needs to addressing their chronic loneliness.

      To Hann, trainer and manager of volunteers at the Jewish Seniors Alliance, seniors’ rights are human rights.

      Also at the top of her worries is the overprescribing of antipsychotic medications to seniors in residential care.

      “We eventually lose some of our loved ones because they start fading away from us,” Hann said in an hourlong January 20 webinar hosted by the South Vancouver Seniors Network.

      Statistics show that B.C. seniors in care are being given these pills at far higher rates than seniors in care in Alberta and Ontario. At the South Vancouver Seniors Network’s February 10 webinar, Hann had a chance to raise these concerns about antipsychotic medications with B.C.’s seniors advocate, Isobel Mackenzie, who joined the group that day.

      According to one of Mackenzie’s reports, nearly one in three seniors in care were being prescribed antipsychotic medications in September 2020.

      In the preamble to her question, Hann told Mackenzie that “many, many residents are given their cocktails at 7 o’clock at night”, whereas others are receiving them in the afternoon.

      “So instead of having physical restraints, we have medicine that’s restraining them,” Hann maintained. “So they become very lethargic. Relatives can’t interact with them.”

      Hann acknowledged that antipsychotic medications are used to treat schizophrenia, but she questioned why they’re being dispensed to so many residents in nursing homes.

      “Will there be a time when we can say that cocktail will not be given to residents?” Hann asked.

      Mackenzie responded that antipsychotics are a “behaviour-altering drug”.

      “B.C., for whatever reason, has always been less successful than other big provinces, like Ontario [and] Alberta, for example, in its use of antipsychotics,” Mackenzie said. “Our use has always been above the national average—and significantly higher than Alberta and a fair bit higher than Ontario.”

      In a November 2020 report called Staying Apart to Stay Safe, Mackenzie revealed that there was a seven percent increase in the proportion of B.C. long-term–care residents who were dispensed antipsychotic medicines from March 2020, when the pandemic began, to the end of September 2020. In the webinar, she attributed some of this to “culture and practice” in care homes.

      “It is sometimes done on the auspices of the effect of this person’s behaviour on the other residents, for example,” Mackenzie said.

      She added that she has seen families “get swept up in this” when they see a parent overly agitated. “The most immediate relief is the pharmacological intervention,” she said.

      Isobel Mackenzie is B.C.'s seniors advocate.

      In other instances, care homes try to manage behaviour before it reaches a “tipping point”.

      For the most part, Mackenzie revealed, doctors are prescribing antipsychotics based on input from nursing staff resulting from what they hear from care aides.

      In many cases, Mackenzie said, the director of care will phone a physician and ask for an order of medications that can be dispensed by nurses in care homes on an as-needed basis rather than in a prescribed regimen.

      Because physician visits to care homes dropped significantly during the pandemic, Mackenzie said that generally—though not exclusively—doctors are not seeing the patients in person who are receiving antipsychotic medications.

      “That’s part of the problem, for sure,” Mackenzie said.

      Hann said that this should raise “incredible red flags”, suggesting that dispensing antipsychotic medications to agitated residents is an “easy fix” for staff in care homes.

      The South Vancouver Seniors Network was launched by Michael Lee, the B.C. Liberal MLA for Vancouver-Langara, and and Andrea Krombein, seniors outreach coordinator for Marpole Oakridge Family Place,

      The network's webinars, hosted by Krombein and Hann, aim to connect seniors with government, community leaders, and other decision makers.