Dementia strategy includes antipsychotics at times

By Gillian Slade on January 6, 2018.

gslade@medicinehatnews.com  @MHNGillianSlade

The appropriate use of antipsychotic medication is part of the provincial government’s Dementia Strategy and Action Plan and will include dementia care in hospital, says Alberta Health Services.

Health Canada has warnings about antipsychotics, and for some people the side effects of antipsychotics can be irreversible, said Dr. Jim Silvius, gerontologist and provincial medical director, community, seniors, addiction and mental health, AHS.

Antipsychotic medication may be appropriate in some cases, for a limited time.

The use of physical restraints should only be a last resort.

“Heavens, I would never use physical restraints if I could possibly avoid it. I think in my career I have ordered physical restraints about twice and that was 30 years ago,” said Silvius. “Physical restraints typically make people worse. How would you like to be tied up?”

For Monica Hazzard, resident of Redcliff, implementing the Dementia Strategy can’t happen quickly enough. She feels the use of antipsychotics and then physical restraints created a viscous cycle for the past six months of her mother’s life in hospital.

The antipsychotics appeared to make her mother more anxious and agitated. Finally her mother was restrained in a chair with her wrists tied to the arm rests, another between her legs and one around her waist. She was told it was for safety reasons to avoid her mother getting up and possibly falling.

“She was in pain from the restraints. She was so agitated and couldn’t do anything but tear her clothes,” said Hazzard who believes families need to be heard and acknowledged by hospital staff.

Drew Barnes, MLA for Cypress-Medicine Hat, is horrified to hear what Hazzard’s mother had to endure.

The alternative to physical restraints do not have to be labour intensive — if you know what they are, said Silvius.

Antipsychotic medication may be appropriate when someone with dementia is first admitted to hospital, and is perhaps anxious in unfamiliar surroundings, but it should then be slowly reduced, said Silvius.

A total of $4.1 million is already being spent on a “seniors health strategic clinical network,” which includes pilot programs that integrate exercise, art and music in dementia care.

“We’ve actually done education sessions on antipsychotics across the province … We’ve done training sessions in all five zones related to the dangers of the antipsychotics,” said Silvius.

There are times where in order to protect the person, or others, you have to do something in a hurry, said Silvius. They have perhaps developed delirium on top of their dementia. There are times where antipsychotics have a very limited role managing that delirium but not the dementia. There needs to be a planned withdrawal of these agents at defined periods of time to see if they are still needed.

The use of antipsychotics for those with dementia was rolled out by AHS first in long-term-care facilities. It is being introduced in supportive living residences.

“We are recognizing that there is some transfer of the approach into acute care (hospital settings) because many of the docs who work in the other settings work in acute care as well. There’s not a formal program in acute care yet,” said Silvius.

Resources are limited and it was decided to do it sector by sector rather than try and do it across the whole system, said Silvius.

The long-term care program introduction took two years and AHS in part way through supportive living.

“Acute care will be next. That’s my anticipation but we have not confirmed that in discussion with the steering committee,” said Silvius.

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