EDMONTON – Alberta is leading the rest of the country in reducing potentially harmful drugs for patients with dementia. And families are watching their loved ones “come alive” again.
The national initiative to reduce antipsychotic medication use in long-term care facilities began in 2014. At that time, about 30% of long-term care residents in Canada were on the drugs, with an average of 27% in Alberta.
Two years later, the national average has dropped to about 27%. And Alberta has the lowest rate in Canada with an 18% average. (Calgary averages 16%, Edmonton 15%.)
Antipsychotics (most commonly Quetiapine and Risperidone) are often prescribed when patients with dementia become agitated or aggressive, to keep them from hurting themselves or others. In an exclusive interview with Global News, Dr. Duncan Robertson, Medical Director of the Seniors Health Strategic Clinical Network, suggested the prescriptions are appropriate for short-term safety. But many patients stay on the drugs for decades, with potentially harmful side effects.
“[Side effects include] increased risk of stroke, or falling, and of actually creating more confusion in the individuals,” said Robertson, “And sedation. So [patients] can’t engage in normal activities.”
Removing the drugs for 900 residents has meant a culture change for all 170 long-term care facilities run by Alberta Health Services. Staff, including physicians, nurses, nursing aides and pharmacists, attended workshops to learn how to deal with dementia behaviours, without resorting to drugs.
At Extendicare Holyrood in Edmonton, staff pay more attention to basic needs: Does the patient need to go to the washroom? Are they hungry? Tired? In pain?
“Lots of teams said, ‘We didn’t realize how much pain [patients] might have been in, and so they were acting out, or having these responsive behaviours’,” said Mollie Cole, Manager of the Seniors Health SCN. “So when we took down the antipsychotics and gave them more Tylenol… their behaviours are way calmer.”
Other calming techniques included music therapy, exercise, afternoon naps and evening baths.
91-year-old Louis Derkach couldn’t walk, talk or even feed himself two years ago. About a month after he was taken off Quetiapine, the Holyrood resident started doing all three things again.
“That’s a long, long way from when he came in here, and it’s awesome to see,” said his daughter, Carol de Jong, as Derkach chats about what he wants for lunch.
“We can talk with him. We can visit. He has lots to tell us.”
Derkach was prescribed the antipsychotic after becoming aggressive in a hospital a number of years ago, when a nurse tried to change his shirt. Now Holyrood staff let him stay in pyjamas if he chooses, and don’t move him until he wants to move.
The unofficial motto, according to Cole: “If you don’t insist, they won’t resist.” And in her twenty years as a registered nurse, this project has been the most rewarding.
“It is the most exciting thing I’ve worked on,” said Cole with a smile. “[Patients] started waking up.”
“‘They’re waking up!’ is what we hear all over the province.”
© 2016 Shaw Media