Reducing medication usage by long-term care residents

June 23, 2014

Marshall Bye enjoys some quality time with his wife of 60 years, Evelyn, in her Calgary long-term care facility.

New ways to manage behavioural challenges are having positive impacts

Story by James Stevenson; photo by Paul Rotzinger

Marshall and Evelyn Bye made the most of their 60 years of marriage, enjoying dancing, travelling the world and sharing more than a few laughs.

But Evelyn, who had been struggling with dementia for the past decade, began to deteriorate. She spent most of her days sleeping and could barely recognized Marshall or acknowledge his daily visits to the long-term care facility.

So when Marshall was told of a new and innovative approach to better manage anxiety and behavioral challenges associated with dementia patients by reducing the use of powerful and potentially harmful drugs, he was quick to sign Evelyn up.

“I have always had faith and confidence in the staff and felt that we had little to lose and lots to gain,” says Marshall.

“Her eyes began to sparkle, and I could see joy in them again.”

Led by the Seniors Health Strategic Clinical Network and the Addiction and Mental Health Strategic Clinical Network, 11 long-term care sites across the province are helping to research, review and implement new guidelines around the appropriate use of antipsychotic medications.

“Some drugs prescribed for elderly persons to treat their behavioural challenges can have serious side effects and medical complications including increased risk of falls, strokes, and confusion, loss of independence and over-sedation,” says Dr. James Silvius, Provincial Medical Director, Seniors Health and co-chair of the Appropriate Use of Antipsychotics in Long-Term Care Project Steering Committee within Alberta Health Services (AHS).

“We want to make sure these residents have the best quality of life as possible and therefore we are looking at different approaches to treat challenging behaviours associated with dementia, rather than using traditional drugs.”

Dr. Silvius says antipsychotic medications were originally created to help treat some mental health illnesses. “However, current research is showing there are other ways of managing the needs of long term care residents who have challenging behaviours associated with dementia without the adverse side effects and harm that these medications may cause.”

The project aims to help staff manage residents’ challenging behaviours by looking at alternative treatments such as music, exercise and art. It also ensures residents, families or alternate decision makers, physicians, and staff work together to investigate and trial innovative approaches to help reduce agitation and anxiety.

Approximately 250 residents at the 11 sites are taking part in the project and preliminary data is positive, showing more than 35 per cent of those residents are no longer using an antipsychotic.

The project trial at the 11 sites ended in February 2014. The Strategic Clinical Networks (SCNs) are reviewing the findings and working towards implementing the new and innovative approaches in the other 164 long-term care sites in the province, which account for about 14,500 long-term care beds. By March 2015, it is hoped that all long-term care sites across the province will be following the new guidelines.

Helping profile the reduced use of antipsychotics project brought television and media attention to the Byes. And while Evelyn passed away in May 2014, Marshall believes she had become sufficiently aware of her surroundings that she knew what he was talking about when he showed her the newspaper with their story.

“I told her: ‘You are a very important woman, with your picture in the newspaper and on TV.’ She preened! I was so happy.”

The Seniors Health SCN and Addiction and Mental Health SCN are two of 10 such AHS networks using unique approaches to create big improvements within focused areas of health care. Albertans deserve a high-performing health system and SCNs are making that a reality by working with a wide group of partners – from patients and their families, to health care professionals, governments, researchers, academic partners, and community and not-for-profit groups – to find solutions to complex health care issues. To learn more about SCNs or to see how you can become part of reshaping health care, visit: the Strategic Clinical Networks.