BACKGROUND FOR THIS SESSION:
Questions posed to ILTCCABC:
How can we improve our understanding of antipsychotic and other medication use?
How can family caregivers play a role in advocating for more and better communication regarding polypharmacy (when a person takes multiple medications at the same time. It’s a common problem for older people who often have many chronic conditions). and deprescribing in our care homes?
And how can we best support our residents if their health and quality of life declines as a result of antipsychotics being administered?
That is how we came to reach out to Wade Thompson.
Our Presenter: Wade Thompson
Wade is a pharmacist practicing in long-term care in Vancouver and an Assistant Professor in the Faculty of Medicine at UBC. He is a co-lead of deprescribing.org and a member of the Therapeutics Initiative. His work focuses on supporting clinicians and residents/care partners in making medication decisions.
Presentation slide Deck: CLICK HERE
The Office of the Seniors Advocate www.seniorsadvocatebc.ca 10th Edition Monitoring Seniors Services 2024 Report revealed:
The proportion of LTC residents taking antipsychotic medications without a diagnosis of psychosis in 2023/24 increased to 29.5%, the highest in the last five years.
Over the past decade, progress has been made in reducing antipsychotic use in long-term care. However, since the pandemic, rates have been rising, emphasizing the ongoing need to prioritize tested, safer, person-centred alternatives to support people living with dementia.
RESOURCE:
Watch the ‘Shared Decision-Making Conversations” videos illustrate how shared decision-making discussions could look. They could be used as part of new resident/caregiver orientation, education sessions or staff training. Like all of our LTC resources, these videos were co-developed in partnership with LTC stakeholders, including caregivers.
https://deprescribing.org/resources/deprescribing-in-ltc-framework
Deprescribing – the process of tapering, stopping, or withdrawing medications that are unnecessary or inappropriate – is an effective way to minimize polypharmacy and improve health outcomes. However, it can be a challenge to know when, how, and which medications to discontinue in the LTC.
Also, the use of PRN psychotropic medication, such as for example, Haloperidol, Lorazepam, Promethazine during inpatient treatment is common practice. Families are concerned they are not being informed when PRNs are administered because it is not a “new” medication and can be used “as needed”.
“PRN” medications are medications that are taken as needed. Meaning, you can take them based on the symptoms you’re currently experiencing. You generally don’t need to take them every day. Some common PRN medications are ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and diphenhydramine (Benadryl).
Four Target Behaviours to Promote a Culture of Deprescribing is included and worth reading here:
https://deprescribing.org/resources/deprescribing-in-ltc-framework/
It appears that Ontario has a deprescribing framework in place or in progress. BC has yet to create a framework such as this.
Island Health has done a great job with their recent Gold AwardJae Yon Jones, Reimagining Long-Term Care: the Appropriate Use of Antipsychotics Initiative
Scroll to 35.50 in the presentation:
https://vimeo.com/1034652493
