Over-use of medication for seniors in care homes across B.C. is an ongoing concern for doctors, but sometimes drugs are prescribed for a result different from their original intended purpose.
Northern Health northwest medical director Dr. Jaco Fourie said some antipsychotics can even be a second-line treatment for agitated major depression.
“Antidepressants can help with sleep disorders or chronic pain management. It’s perfectly reasonable and science-based to do that,” said Fourie.
At the same time Fourie acknowledged that there are patients who are on antipsychotics and shouldn’t be.
“I don’t think we can gloss over it or ignore it,” he said.
B.C. seniors advocate Isobel Mackenzie earlier this year released a residential care report which lists statistics for facilities around the province, including Mountainview Lodge at Kitimat General Hospital, comparing those statistics with the provincial average.
The percentage of Mountainview residents receiving depression medication is 54.1 per cent, compared to the provincial average of 47.8 per cent, while the percentage of residents taking antipsychotic drugs without a diagnosis of psychosis is 22.2 per cent, below the provincial average of 24.5 per cent.
The percentage of residents diagnosed with depression is double that of the provincial average, 54.1 per cent compared to 24 per cent.
Fourie said part of the problem is that a medication is sometimes intended as a short-term solution, but becomes long-term because follow up is overlooked.
He added that doctors have to make difficult decisions, interpreting what patients are telling them and deciding on what the best way to help is.
“When a doctor asks “how are you doing?” and a patient says they’re “doing good,” a doctor has to make a judgment call. (As a doctor) you don’t know if that’s because of the medication, or because there’s an improved family dynamic, or they’ve started a new relationship,” said Fourie.
“Doctors are very apprehensive about stopping medication when they see somebody who was previously distressed doing better, especially if you have an elderly patient who is struggling with other things as well.”
Fourie said Northern Health is looking to improve care for seniors in the future by attaching family doctors to care facilities and requiring medication reviews to be done twice a year, with a pharmacist, to help address the medication issue.
“It’s during those reviews that we will find that diagnoses are scrutinized, and medication lists whittled down,” said Fourie.
Seniors Advocate Isobel Mackenzie said while almost half of B.C. residents in care are on depression medication, only 24 per cent of them were diagnosed with depression.
In addition, nearly 25 per cent of seniors in B.C.’s publicly-funded care facilities are taking antipsychotic drugs without a diagnosis of psychosis (for mental disorders such as bipolarity or schizophrenia).
“It’s what’s called an off-label use of the medication,” explained Mackenzie. “The doctor is prescribing it for something other than what it was intended to treat. It happens quite a bit.”
As a society we’ve learned that it’s not the best way to treat people, Mackenzie said, and different types of therapy are often more effective.
Side effects can also be harmful and can actually exacerbate delirium or dementia and their symptoms, she added.
Mackenzie says she’s encouraged by the statistics that show a decrease in off-label use of antipsychotics over the last several years. Numbers went down seven per cent in B.C. in the last four years, from 33.2 per cent in 2013-14 to 25.9 per cent in 2016-17.
“It’s actually decreased quite a bit,” she said, “but we’re still higher than other provinces.”
“On the antidepressant side we’re stuck,” she added, noting that no improvement has been made with the off-label use of that medication.
Family advocacy note
Senior care homes are not required to report to their family advocate about changes to their loved one’s care.
However, if they ask for a report, a family advocate does have the right to get reports on changes to their loved one’s medication and care.
Families should also be aware that antidepressant and other medication side-effects can mimic symptoms of dementia and aging.
The Office of the Seniors Advocate has an online database for families to look up specific statistics on each care facility at www.seniorsadvocatebc.ca/quickfacts