Rise in antipsychotic medication use in B.C. long-term care homes worries seniors' advocate

British Columbia's seniors' advocate says she was alarmed to discover a 10 per cent increase in the use of antipsychotic medication in long-term care homes over the past year. 

Isobel Mackenzie says the use of antipsychotics in long-term care homes was identified about a decade ago as an indicator of the quality of care that residents are receiving, and her office regularly monitors it with the use of PharmaCare data. 

"In my time of looking at these data, I've not seen that type of increase in this short a time frame," Mackenzie said.

"And so that is of concern. These are powerful drugs."

The primary purpose for antipsychotic drugs, once known as tranquillizers, is to treat psychological conditions like schizophrenia. Mackenzie says they are sometimes used in long-term care homes to manage behaviour of some residents with dementia, like aggression or restlessness. 

Quality human interaction needed

Physician and University of British Columbia assistant professor Dr. Rita McCracken has researched the use of antipsychotics in long-term care homes. McCracken says the drugs have been shown to increase mortality, falls and strokes when used in that capacity. 

She says the best way to treat symptoms in patients with dementia is quality human interaction with a familiar face — something that has been in short supply during the pandemic as visits with family have been extremely limited, care providers have had to wear medicalized garments and regular activities have been cancelled in long-term care homes in order to minimize the risk of spreading the virus.  

She and Mackenzie suspect that the symptoms of residents with dementia have likely become worse because of these changes, prompting an increase in antipsychotic prescriptions. But McCracken isn't sure what could have been done to prevent it. 

"I know everybody who's working is doing their very best for the needs of everybody there," McCracken said. "This is the first pandemic of our modern times and there was no playbook for it." 

'A convenient way to manage behaviour'

Terry Lake, CEO of the B.C. Care Providers Association, agrees that the rise in antipsychotic use is concerning, especially given that about 60 per cent of long-term care residents have some form of cognitive impairment. 

Lake says the drugs are prescribed by physicians, not staff, but during the pandemic most appointments with doctors have been virtual rather than in-person. 

"Unfortunately I think it's been maybe a convenient way to manage behaviour when physicians aren't on site and to deal with it in a more holistic way," he said. 

Lake remembers dealing with this issue when it gained traction years ago while he was the province's health minister. He says health officials were able to manage the issue then, and he hopes they will be able to do so again soon. 

Mackenzie also hopes the use of anti-psychotics in long-term care homes will begin to decrease again now that restrictions in facilities have eased up. 

She says she'll continue to keep a close eye on the data to make sure the gains made in the past decade don't disappear. 

"Yes, we will likely, I suspect, improve," she said. "But there is going to be a whole cohort of seniors who went through this experience for whom there won't be any improvement because they will have passed away."