Seniors in care homes across B.C., including Terraceview Lodge, are still being given medications they are not diagnosed for, an issue that’s improving but still an ongoing concern in B.C.
B.C. Seniors Advocate Isobel Mackenzie released report and residential care home Quick Facts Directory early this year, highlighting several concerns around seniors care.
One of those concerns is the off-label use of medication.
The report says that almost half of B.C. residents in care, 47.9 per cent, are on depression medication but only 24 per cent of them are 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 (mental disorders such as bipolar or schizophrenia).
The percentages are better in Terraceview Lodge, which has nearly 35 per cent of residents on antidepressants, just under 11 per cent of whom have no diagnosis of depression.
Another 13 per cent were taking antipsychotic medication without that particular diagnosis.
“It’s what’s called an off-label use of the medication,” explained Seniors Advocate Isobel Mackenzie. “The doctor is prescribing it for something other than what it was intended to treat.”
“It happens quite a bit,” she said.
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.
Dr. Jaco Fourie, northwest medical director for Northern Health, said the over-use of medication is an ongoing concern for doctors but sometimes off-label use of medication does address concerns.
Antipsychotics can be a second-line treatment for agitated major depression, he said, and 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, he did acknowledge that there are patients who are on antipsychotics and they shouldn’t be.
“I don’t think we can gloss that over it or ignore that,” he said.
Part of the issue is that a medication is sometimes intended as a short-term solution, but becomes long-term because follow up is overlooked.
And doctors do have to face very real challenges of discerning what people say and deciding on what’s best to help.
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 improved family dynamic or they’ve started a new relationship,” said Dr. Fourie.
“Doctors are very apprehensive about stopping medication when they see somebody who was previously distressed doing better now,” he said, “especially if you have an elderly patient who is struggling with other things as well.”
“To stop that medication… and risk somebody getting really sick… that’s a tough go. That’s a really tough go,” said Dr. Fourie. “And people suffer as a consequence.”
Dr. Fourie says Northern Health is looking to improve the care for seniors in the future.
They plan to attach family doctors to care facilities and require 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 Dr. Fourie.
But that trial project is on hold for now.
“Our problem right now is our capacity in Terrace,” said Dr. Fourie. “There is not a lot of capacity and time to participate in the type of quality activities that our elderly would need in the long term.”
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 B.C. seniors advocate also now has an online database for families to look up specific statistics on each care facility at www.seniorsadvocatebc.ca/quickfacts