B.C. Seniors Advocate says many LTC residents are prescribed antidepressants they don’t need

A new report finds many Canadian seniors in long-term care (LTC) have been prescribed antidepressants and antipsychotics they likely didn’t need.

The Canadian Institute for Health Information (CIHI) says over the past five years, seniors in LTC were three times more likely to be given antidepressants than those living in the community.

Meanwhile, the report finds seniors in LTC were also eight times more likely to be prescribed antipsychotics than those not in a facility.

Growth in prescriptions through the pandemic was higher in antidepressant medications than the latter.

“During the pandemic, the growth in prescriptions for antidepressants among seniors living in LTC was higher (from 62 per cent of residents in 2019 to 65 per cent in 2021) than for seniors living in the community (from 22 per cent in 2019 to 23 per cent in 2021). Though these percentage increases were relatively small, they represent about 140,000 more seniors being prescribed antidepressants overall,” CIHI says, adding antipsychotic prescriptions for LTC seniors grew from 37 per cent in 2019 to 43 per cent in 2021.

B.C. trends higher for unnecessary prescriptions: report

While CIHI noted a rising trend in the rate of prescriptions across Canada, B.C. Seniors Advocate says this province has always been above the national average.

“We’re significantly above Alberta and Ontario. And the question is our population in long-term care isn’t different — in fact, arguably, when you look at the data, our population in long-term care is less complex and frail than the population certainly in Alberta and Ontario — so why are we prescribing this medication to a greater degree?” asked Isobel Mackenzie, who notes her office found that over half of B.C. seniors in LTC in 2021 were prescribed anti-depression medication.

“The proportion of residents diagnosed with depression remained relatively stable at 23 per cent in 2020/21 and the proportion that received antidepressant medication increased slightly to 51 per cent. More than twice as many residents were on antidepressants than those with a recorded clinical diagnosis of depression,” Mackenzie’s report reads.

“In 2020/21, the proportion of residents taking antipsychotics without a diagnosis of psychosis increased 8 per cent over the previous year.”

The report goes on to note that the rate was slightly higher in health-authority-owned facilities than contracted ones.

Why is this happening? 

When it comes to the reasons behind why a resident would be given a drug they don’t necessarily need, Mackenzie says the answer isn’t always very clear.

“It’s an interesting question because how much of this is the changing condition of the resident and how much of it is our changing perception of the conditions of the residents?” she asked.

“When we look at the behaviours, are behaviours fundamentally changing in long-term care? Many of us don’t really think so, the evidence is not supporting that. But our response to behaviour has been changing over time and some of that response is medication. Some of the reasons we give is to protect the other residents, to protect the staff, and to protect the resident themselves. But as we continue to lower the bar around what we think is within the confines of acceptable behaviour, we’re going to find ourselves increasingly prescribing these medications.”

While she notes medication can be a form of treatment, it’s not the only solution.

She points to research that promotes certain behaviour-modifying activities and engagement.

“It requires training, it requires time, and it requires staff — all of which have been in short supply with COVID. Arguably they were in short supply before COVID but certainly ramped up during COVID and we continue to see it now,” Mackenzie told CityNews.

“So how much of this is because we don’t have the resources to handle these behaviours, to create behaviours from escalating? One of the big things is how do you prevent somebody from becoming agitated to the point where we want to prescribe the antipsychotic? And there are ways to do that. It requires time, patience, training, and familiarity with the resident, all of which are challenged in our current staffing world.”

Mackenzie says B.C. needs to take another look at the rates of medication as a quality of care indicator, and create targets to bring these numbers down.