Antipsychotic Medication use in Elderly

Managing Behaviours with Resident Centred Approach to Care

Southampton Care Centre, Long term Care

The risks associated with Antipsychotic use in the Elderly with dementia include: Sedation, Anticholinergic symptoms, Orthostatic hypotension, Extrapyramidal symptoms, QTc prolongation, Metabolic side effects, Acute Kidney injury, cerebral vascular adverse events, cognitive decline and even death.

Well before the multitude of media releases that portray long term care as a place where residents are overmedicated or improperly medicated with antipsychotic medications, a little long term care home in Grey Bruce had already addressed the issue.

In December of 2012, at the Southampton Care Centre's Professional Advisory Committee meeting our Pharmacist presented our medication statistics and identified that we had a problem that was gradually getting worse.  Our antipsychotic use for our residents without supporting diagnosis was high - 49% of our residents had been prescribed regularly scheduled and/or prn medications. We needed to take immediate and expansive action.

Our medical advisor, Dr. Nadine Dickie took the lead to educate our physicians. With the Physicians and our Pharmacist on board we began our journey to change.

In conjunction with our newly developed BSO team, our existing Responsive Behaviour Committee and our BSO consultation team we set out to not only reduce the use of antipsychotic use but to initiate and encourage non-pharmalogical interventions for responsive behaviours.   

Basically, we had to change the culture of our home and our response to residents with responsive behaviours. 

Education was the major component to changing the mind set about the use of antipsychotic medication and sway it toward alternate assessment and intervention.  

Enter the corporate wide adoption of REC (Resident-Lead Events and Clubs) and extensive education on Maria Montessori techniques for care, PIECES Training and Gentle Pursuasive Approach.  These early concepts help paved the way for the Care Centre's adoption of Gail Elliott's DementiAbility philosophy. All of these initiatives together started changing resident outcomes.

Near the end of 2014 Antipsychotic use (without a supporting diagnosis of psychosis) dropped to 18.4%. Currently as at August 1, 2016 that figure is 13.9%.  Those are great numbers of course but it is the residents' quality of life and safety that is most impacted.

MEET DOUG: Doug Needs, a 61 year old resident of the Southampton Care Centre is one of the busiest resident volunteers at the Jarlette Health Services long term care home.

Up until the summer of 2009, Doug had been supported by Community Living in Kincardine. He kept himself busy with his job at the post office delivering flyers with a red push cart though out the neighbourhood. Some medical issues and his poor vision and hearing made it too risky for him to continue to live independently. Without any family to speak of, Doug moved into long term care.

It was a difficult transition for Doug initially.  He struggled with his communication and had some responsible behaviours.  Instead of turning to Antipsychotic medications, we looked to his motivations, a resident focused approach.

Being a bit of a younger than average resident, the staff where challenged to get Doug involved in activities. No matter what they tried, he didn’t want to join in. He didn’t like crowds and seemed to gravitate his social engagement with staff rather than co-residents. Doug talked about his old ‘job’ delivering flyers and how he missed it. He was bored. He wanted something meaningful to do, something to take pride in.

“Oh, we found him a few things to do alright!” says Deanna Crowe, Responsive Behaviour Committee lead.  Doug just needed a job!.

Doug wears his volunteer button proudly as he busies himself everyday at the Care Centre. “Doug takes his jobs very seriously and never forgets when it is box day or shred day. He has become our co-worker in a way” says Steve Argue the Environmental Services Supervisor.

Doug does not want to be entertained. He wants to help. He will bi-pass the jazz band in the activity room to assist Steve with something that needs to be fixed.  Steve got Doug his own cart, a nice red one.

In the process of working with individual staff members he developed relationships with them. “Doug didn’t just become a resident or a volunteer here. He became our friend.’ says Brenda Ohm, the Care Centre’s Administrator.

“There she is!  The boxes are here!” he shouts excitedly, high fives and giggles at Andrea Prentice, Resident and Family Services Co-ordinator. Doug helps her put the incontinence product delivery away every week.  

Doug also hands out clothing protectors before meals, helps Steve with lots of projects and collects all the shred boxes. He accompanies the assistive devices maintenance person twice a month and cleans up dishes after all snack carts.

Doug straightens up chairs and helps move tables for activity programs. He folds towels with a co-resident, sometimes up to nine baskets a day. He couriers paperwork from the office to managers and the nurses’ stations.  Doug arranges and sorts the Dementiability baskets for other residents. He also helps the DOC put away her supplies. In total Doug volunteers roughly 20 hours a week if not more, to a total of over 1000 hours a year.

Every Friday afternoon after his work week, Doug is treated by the Administrator to pop and chips.  Paid also with high fives and friendships, Doug doesn’t think of himself as a volunteer. He grins from ear to ear with every task he does, happy to have something to do that is meaningful to him. He takes great pride in his work and looks forward to his jobs with his friends at the Southampton Care Centre.  Doug was nominated in 2016 for the OLTCA’s Circle of Excellence Award for his volunteerism. 


Reducing Anti-Psychotics
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