Updated best practices guide to cut antipsychotics use in residential care

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By Rumana D’Souza

Over the last decade, the overuse of anti-psychotics in residential care has raised public concerns about the health and safety of residents and care providers alike.

The BC Care Providers Association released the Best Practices Guide for Safely Reducing Anti-Psychotic Drug Use in Residential Care in 2013. The Association’s Policy & Research Department is working towards releasing the 2017 Best Practices Guide this fall to continue helping care providers lower the use of anti-psychotics among seniors under their care.

The Canadian Mental Health Association defines anti-psychotics as drugs used “to treat the severe distortions in thought, perception, and emotion that characterize psychosis.”

Although originally developed to treat schizophrenia and bipolar disorder, they are being increasingly prescribed to treat behavioural and psychological symptoms associated with dementia.

According to a 2016 report from the Canadian Institute for Health Information, nearly half of all older adults living in long-term care facilities in Canada are prescribed antipsychotic drugs.

According to PharmaNet, 50 per cent of all seniors in residential care in B.C. were prescribed anti-psychotics between April 2010 to June 2011—a figure that jumped from 47 per cent in 2006 to 2007, and 37 percent in 2001 to 2002. Over 450,000 anti-psychotic prescriptions were handed out in B.C. between April 2010 and June 2011—at a cost of $9.2 million to PharmaCare.

Over-medication is an issue among all aging adults, not just those in residential care. The BCCPA released a Backgrounder on Reducing Polypharmacy in B.C.’s Continuing Care Sector in 2016 that highlights the larger issue of polypharmacy among seniors, and also addresses specific concerns about anti-psychotics, anti-depressants and off-label drug use.

In 2012, B.C.’s Ministry of Health warned the public of the link between anti-psychotics and an increased risk of illness and mortality in dementia patients—for which reason the drugs should be used with caution.

Not only does the overuse of anti-psychotics pose a risk to the health of residents, it can also compromise the safety of staff. Strategies outlined in the guide ensure residential care homes are a safe place to work for care providers.

Like the 2013 Best Practices Guide, the updated version will feature successful anti-psychotic drug reduction strategies implemented by several B.C. residential care providers who are members of the Association.

Lara Croll, Policy Analyst at the BC Care Providers Association, said interest in the Best Practices Guide from members has been tremendous.

“While there is still more progress to be made, our members are steadily working towards reducing and eliminating the use of anti-psychotics, and using non-pharmacological approaches to care for residents living with dementia and cognitive impairment,” Croll said.

The 2017 Best Practices Guide will profile Menno Place, Creekside Landing (Kaigo), Park Place Seniors Living, Arrowsmith Lodge, and KinVillage among many others.

Some of the strategies to be outlined in the 2017 guide include:

Participating in formal polypharmacy reduction initiatives, including CLeAR (Call for Less Anti-psychotics in Residential Care).

Providing all staff with education and training on person-centered care, violence prevention, and working with people with dementia.

Working with pharmacists and physicians to reduce or eliminate anti-psychotics prescriptions, where appropriate.

Engaging with families to educate them about the potential risks of anti-psychotics.

Croll added the guide will be of use both to care providers looking to begin work on this issue, and those looking to enhance their existing initiatives.

Rumana D’Souza is the Digital Media & Communications Coordinator, BC Care Providers Association.

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