Overuse of Antipsychotic and Sedative Medications in Long-Term Care

Overuse of Antipsychotic and Sedative Medications

Families and representatives often express concerns about medications that are prescribed to long-term care residents, particularly anti-psychotic drugs and sedatives. Their concerns are:

1. whether the medication is being used to treat a condition or being used to subdue the resident;

2. whether the benefits of the drug(s) outweigh the risks for the resident; and

3. the lack of informed consent to the medication––usually meaning a lack of proper consultation with the resident or substitute decision-maker responsible for consenting to health care.

Overuse of anti-psychotic medications in seniors’ care is a long-standing problem. Such drugs are often prescribed to residents who may have dementia but no diagnosis of psychosis and may be prescribed without a full discussion of their risks and benefits with the resident or their substitute decision-maker. This violates the basic principle of informed consent to health care set out in the Health Care (Consent) and Care Facility (Admissions) Act. Risks of anti-psychotics and sedatives include increased confusion, falls, bedsores, blood clots, and potentially serious or fatal interactions with other drugs the adult may be taking. Medication is health care treatment, and residents or their decision-makers should be fully informed about the risks and benefits of any medications and maintain the right to refuse or consent to their use.<ref>Canadian Centre for Elder Law, Conversations about Care: The Law and Practice of Health Care Consent for People Living with Dementia in British Columbia, CCEL Report #10 (February 2019) at 115-139, online: <www.bcli.org/publication/conversations-about-care-the-law-and-practice-of-health-care-consent-for-people-living-with-dementia-in-british-columbia-full-report/>; Office of the Seniors Advocate of British Columbia, Staying Apart to Stay Safe: The Impact of Visitor Restrictions on Long-Term Care and Assisted Living Survey (November 2020) at pg 6, online: <www.seniorsadvocatebc.ca/osa-reports/staying-apart-to-stay-safe-survey/>. </ref>

Family members may become aware of medications when they see a behavioural change in their resident family member. When raising questions with facility staff, they may be told that the medication is necessary to “manage” the resident, and if discontinued, it would lead to the patient’s deterioration. This also violates health care consent law and the rule against punishing people who make complaints.<ref>Community Care and Assisted Living Act, SBC 2002, c 75, Sch, online: <canlii.ca/t/84lk>. </ref> The use of medication to control behaviour, rather than for therapeutic reasons, is a form of chemical restraint and is subject to regulations about restraint. The next section discuss restraints.

The Ministry of Health recognized the overuse of antipsychotic medications in care facilities and set guidelines to help service providers respond to behaviours with strategies to attempt before medication. These include thorough assessment of the resident, trying less risky interventions, and carefully weighing risks against benefits of various options.

Note that in some cases, antidepressants may be prescribed without a diagnosis of depression, as they are often effective for the management of chronic pain. This is not considered a chemical restraint unless it is used to control behaviour.

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References

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Seniors First BC, February 2024.

(1) Agreement, or (2) the giving of permission for a thing to happen or not happen.

In law, (1) a judge's conclusions after hearing argument and considering the evidence presented at a trial or an application, (2) a judgment, or (3) the judge's reasons. A judge's written or oral decision will include the judge's conclusions about the relief or remedies claimed as well as their findings of fact and conclusions of law. A written decision is called the judge’s "reasons for judgment." See "common law," "conclusions of law" and "findings of fact."

The right of a person to bring a particular claim under a particular act before a particular court. In most cases, someone who does not have a direct interest in a dispute will lack standing to be a party in a proceeding.

A kind of legislation that provides supplemental rules for a particular act. Regulations are created and amended by the government, not by the legislature, and as a result the legislature has no say in how or what regulations are imposed by government. See "act."

In law, to formally deliver documents to a person in a manner that complies with the rules of court. Service may be ordinary (mailed or delivered to a litigant's address for service), personal (hand-delivered to a person), or substituted (performed in a way other than the rules normally require). See "address for delivery," "ordinary service," "personal service" and "substituted service."