Resident Stories

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Going Off Antipsychotic Drugs Brings Back Gleam in Dad’s Eyes

What’s it like to see someone you love on antipsychotic medication? For whatever good it supposedly does, Patty B. saw only this in her father’s eyes. “He was zoned out,” she says. “You couldn’t talk to him. I was glad my mom wasn’t around to see it. She would have been devastated.”

Antipsychotic Reduction Collaborative

Don, now 86, was medicated after acting out at Camilla Care Community in Mississauga, Ont. Today, Don is much more alert. Patty can have conversations with him. The change came after he was weaned off the antipsychotic drug.

Camilla is one of 56 long term care facilities across Canada to participate in a collaborative project from the Canadian Foundation for Healthcare Improvement (CFHI). The goal is to cut the 27.5% seniors in Canadian long term care who are on antipsychotics without a diagnosis of psychosis. These drugs are widely used to address behaviour issues, but can have serious side effects, and contribute to falls and hospitalizations.

The year Don went on the medication, Patty had been through a lot with her parents’ health. Don had been a credit manager, and an avid curler and cottager. Patti describes him as outgoing, a great talker. But after three strokes in five months, he had problems walking and speaking. Don became anxious. Patty’s mother could no longer take care of him.

In February 2008, just before his 78th birthday, Don went into Camilla. Then Patty’s mother fell ill. At first, the diagnosis was unclear. When it came, the news was terrible: ALS. She died in July 2008.

Don’s short term memory had been bad since the strokes. “If you asked him what he had for lunch, he’d say they don’t feed me here,” says Patty. Worse, he started to become aggressive, mostly with other residents and sometimes with staff. Don didn’t remember the incidents.

As a nurse, Daile Moffat spent many years on the frontlines of long term care. She understands the perceived benefits of antipsychotic medication, and its potential harms.

“There are circumstances where antipsychotics are warranted. But they’re not the most ideal medication for the elderly,” says Daile, VP, Quality and Consulting Services, Sienna Senior Living.

Camilla is a Sienna long term care community. Daile notes Sienna’s vision to awaken its communities to the positive possibilities of life’s next chapters. “When you awaken someone from antipsychotics, it flows with our vision,” she says. “We saw that through this project.”

The objective was to learn effective ways of reducing antipsychotic use for seniors, using non-pharmacological interventions to modify disruptive behaviours. Instead of being seen as a first option, Daile says antipsychotics should be a last resort.

The best evidence says 5-15% of seniors in long term care should be on antipsychotic medication. In CFHI’s program, over half of residents on antipsychotics had the drugs either discontinued (36%) or significantly reduced (18%). At Camilla and across the Sienna residences involved in the initiative, antipsychotic use was cut in half. “It can be done – and be done safely,” says Daile.

When Patty saw the effects of antipsychotic medication on her father, she assumed it was part of his deteriorating health. Once he was weaned off, “People asked me how my dad was, and I would say he’s surprisingly better,” says Patty.

To Daile, it’s no surprise. When residents are off antipsychotics, “you can see the gleam in their eyes, their personalities come through. You see a real difference.”

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