P.E.I. working to move dementia patients off antipsychotic medications

There are too many seniors in P.E.I. health care facilities who are taking antipsychotic medicines, without a diagnosis of psychosis, say provincial health officials.

28.6 per cent of residents on antipsychotics not diagnosed as psychotic

The Canadian average showed 28 per cent of seniors living with dementia who do not have a diagnosis of psychosis are estimated to be on these medications.

There are too many seniors in P.E.I. health care facilities who are taking antipsychotic medicines, without a diagnosis of psychosis, says provincial health officials.

Close to 29 per cent of residents diagnosed with dementia, but not with psychosis, are on antipsychotic medication.

A new program is working to reduce those numbers.

"We're at 28.6 per cent, and at the time we were just slightly higher than the Canadian average," said Shelley Woods, P.E.I.'s chief nursing officer for long-term care.

The Canadian average showed 28 per cent of seniors living with dementia, and who do not have a psychosis diagnosis, are estimated to be on these medications.

Most of the off-label prescribing of antipsychotic medications is to control behaviour in aggressive patients.

Reducing falls, abuse

This week, a study by the Canadian Foundation for Healthcare Improvement found without the antipsychotics, patients had fewer falls and were less abusive towards others.

The national study of 56 long-term care facilities in 2014 and 2015 found that when antipsychotics were discontinued or significantly reduced:

  • Falls decreased by 20 per cent.
  • Verbally abusive behaviour decreased by 33 per cent.
  • Physically abusive behaviour decreased by 28 per cent.
  • Socially inappropriate behaviour decreased by 26 per cent.
  • Resistance to care decreased by 22 per cent.
Shelly Woods and Jean Fallis say a new approach to patient care is helping reduce the need for medications to control behaviour. (Mitch Cormier/CBC)

Person-centred care

P.E.I. has been working to reduce the amount of medication given to patients in provincially operated facilities as well.

For the last few years provincial manors have been adopting something called person-centred care.

"So we look at their interests, their abilities, what they worked at, their hobbies and we try to gear their activities to those interests," said Woods.       

'Environment is key'

As manors are being replaced, new facilities are built to reduce the stress on residents.

Jean Fallis, who runs Colville Manor in Souris, said residents live in what's called a household — a smaller unit offering everything they need.

"Immediately in moving to the new manor we found that the incidents, the occurrence of responsive behaviours decreased," said Fallis.

"Environment is key as one of the things to change."

Fallis also assigns staff to one area of the manor and does not move them around. Residents get to know their caregivers, and staff become familiar with only a handful of patients.

Fallis said staff are more comfortable with the new approach.

"I know what Mrs. Smith wants for her night lunch, I know that I need to serve Suzie on the left hand side because she can't see out of that eye. It's that precise."

Regular reviews

New manors are being designed creating what's called 'households,' where staff and residents are consistent, mirroring a more home-like atmosphere. (Shutterstock)

The province says the next goal is to reduce the number of patients prescribed off-label antipsychotics.

"We have not decreased the number of prescriptions of antipsychotic medications but we have decreased the number of times that we have had to administer those antipsychotics to the residents," said Woods.

The next phase of the program is to ensure regular medication reviews in hopes of reducing the number of prescriptions in provincially run long-term care facilities.

Private facilities also working on problem 

CBC News also spoke to the P.E.I. Nursing Home Association, which said many of its members are doing reviews to reduce the use of antipsychotics in their facilities as well.

That work is being done with pharmacists and in-house physicians as part of a quality improvement program modeled after the provincial one.