The use of anti-psychotic medications in British Columbia’s long-term care facilities spiked during the first year of the pandemic as residents were heavily restricted in their ability to enjoy regular daily routines, B.C.’s Seniors Advocate has found.
The 2021 update of the Monitoring Seniors Services report, which covers the first full year of the COVID-19 pandemic, found the proportion of long-term care residents taking such medications increased by 7 per cent, and the rate of anti-psychotic use is now the highest in five years, representing a 13-per-cent increase over the rate in 2016-2017.
“It is a significant one-year increase, it’s the largest one-year increase we’ve seen since we’ve been measuring this,” Seniors Advocate Isobel Mackenzie said after the release of her report Wednesday.
“We are continuing to measure it and we need to be aggressively managing that number down.”
Anti-psychotics are often prescribed to control aggression and resistance to care. They are widely prescribed for symptoms of dementia, says Rita McCracken, a Vancouver family doctor and assistant professor in family medicine at the University of British Columbia.
Dr. McCracken said this class of medications increases the risk of stroke and death for people with dementia. However, the drugs can also help with symptoms associated with dementia such as agitation, aggression and hitting.
Possible reasons contributing to the increased use of these drugs include the disrupted lives of residents during the pandemic and the significant reduction in the number of physician visits to long-term care homes, Ms. Mackenzie said.
She explained anti-psychotics are prescribed by physicians, who had to prescribe over the phone without seeing the residents.
Terry Lake, chief executive officer of the BC Care Providers Association, also called the trend concerning.
“Last year, going through the pandemic, what we see is fewer in-person visits by physicians to residents of long-term care. And I suspect that is a factor in the prescribing of anti-psychotics. So hopefully, this is a bit of a blip, a bit of a setback, because of COVID,” Mr. Lake said.
Data collected by the Canadian Institute for Health Information showed between 2020 and 2021, 22 per cent of those receiving anti-psychotic medication in long-term care facilities were being given the medicine without ever having been diagnosed as psychotic. In B.C., that number was 26.5 per cent. The rate reached 30.5 per cent in Saskatchewan and was below 20 per cent in Alberta and Ontario.
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Both Mr. Lake and Ms. Mackenzie said significant progress had been made prior to the pandemic in reducing the use of anti-psychotics. Both said they are hopeful the combination of reconnecting socialization for residents in care and greater contact with physicians will help.
Dr. McCracken said more skilled staff within facilities are needed.
“Instead of warehousing our elders in the most cost-efficient way, we need to be making investments in having the right staff present there to be able to help these people having these symptoms feel better without needing to meditate them.”
A long-term care directory released by Ms. McKenzie in December points out the rate of using such drugs without a diagnosis of psychosis was slightly higher in health authority-owned facilities (29 per cent) than in contracted facilities (24 per cent).
Wednesday’s report also says the number of subsidized, registered assisted living units has decreased by 3 per cent and private assisted-living units have decreased by 26 per cent. It notes there was an 11-per-cent decrease in the number of long-term care facilities inspected owing to the impact of the pandemic, and average wait times for admission to long-term care increased by 33 per cent.
“That’s also very concerning because we have this huge demographic wave coming at us, of people who will need the services of assisted living and long-term care, and they simply can’t wait longer to get the proper care they need, so the government really needs to address this,” Mr. Lake said.
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Xiao Xu