Those living in a regulated nursing home are likely in the frailest condition of their lives, and approaching the end of life. The individual reasons for entering a nursing home are many, but commonly, residents require intense personal care for an indefinite period of time. Nursing home residents often require significant assistance because many suffer from chronic conditions which impair their capacity to live on their own. Residents rely heavily on the nursing home to ensure their protection and well-being.
So it is paradoxical — some would say tragic — that nursing home residents are too often put on drugs they don’t need, which can be dangerous, and may even kill them.
There is accumulating evidence that antipsychotic medication is used excessively in some nursing homes. A recent Toronto Star investigation revealed that many provincially-regulated nursing homes in Ontario are routinely drugging their residents to calm and restrain them when they are agitated, have a tendency to wander or display aggressive behaviours. It also revealed that 33 percent of Ontario’s nursing home residents are on an antipsychotic drug.
While Ontario is currently in the spotlight, similar headlines appear on a recurrent basis across Canada. A recent report by the Canadian Institute for Health Information found that the odds that a senior person living in a Canadian nursing home will be given antipsychotics are nine times higher than for the elderly living in the community. The report showed that about 41 per cent of nursing home residents in Canada received at least one antipsychotic in 2012.
How long will the elderly in nursing homes be served unnecessary and potentially dangerous drugs when what they actually need are better provisions for long-term care?
Warnings on drugs labels are unequivocal: for those who suffer from dementia, antipsychotics are dangerous. These drugs, when inappropriately prescribed in this manner, may increase the risk of death by 60 percent and can kill. Health Canada does not approve them for the elderly with dementia, yet large numbers of nursing home residents on these drugs suffer from this condition. Residents may also receive other drugs that may be unnecessary and risky for them, such as the anti-anxiety medication lorazepam or the antidepressant amitriptyline.
Ensuring seniors remain calm and easy to manage is not what residents suffering from dementia personally need the most from nursing homes, but this may be what nursing homes need from them. The evidence suggests that in several cases these facilities are using prescription drugs as a cost-effective way to deal with their residents’ unwanted behaviours.
Provinces typically express concern when such issues are raised. Policymakers establish new guidelines, promise to better educate doctors and stakeholders and may even make data about drug use in nursing homes publically accessible. Sadly, this has not been enough as evidenced by the large numbers of seniors in these institutions who continue to take unnecessary medications. More — and different — action is needed to ensure an efficient response.
The evidence suggests that behavioral interventions and improved management of dementia can significantly reduce the need for antipsychotic medication. Such solutions require better-designed, better-equipped and better-staffed nursing homes. How well prepared are we to provide these conditions?
The core problem lies in the largely insufficient funding levels for nursing homes at the same time that this sector is facing a rapidly growing demand for services. Significant investments will be needed for nursing homes even if the goal is limited to maintaining the status quo. Strong determination is needed from politicians and policymakers if they seek to improve the current conditions.
But who will take the lead? Provinces can certainly do better. But some of the tools needed — including better funding and national standards for long-term care — require a meaningful involvement from the federal government. Effective leadership from the federal government is the essential first step.
There’s one thing we know for certain: Using prescription drugs as a response to nursing home struggles with staffing shortages and insufficient resources is not a solution.
Commentary courtesy of EvidenceNetwork.ca