One out of four residents in long-term care facilities receiving antipsychotics without supporting diagnosis

Isobel Mackenzie

B.C. has a rate 19.3% higher than the national average in the use of antipsychotic medication without a supporting diagnosis for seniors living in long-term care facilities, according to data released by the Canadian Institute for Health Information (CIHI).

What is more, efforts in recent years to reduce the number have stalled, with no reduction in the last year. In total, one out of four residents is receiving antipsychotics without a supporting diagnosis.

“Unfortunately the data show that in B.C., for whatever reason, we are not able to make the gains that other provinces have in reducing the inappropriate use of antipsychotics. This is troubling particularly when we look at other data that show our long-term care populations have lower rates of psychiatric and mood disorders and aggressive behaviours than other provinces and while we have a slightly higher rate of dementia, (3.9% higher) we have a lower rate of residents with moderate to severe dementia, (3.8% lower),” said B.C.’s Seniors Advocate Isobel Mackenzie.

The data also highlights that B.C. has the oldest and frailest homecare population in Canada with the second highest rate of caregiver distress in the country.
“We can understand the high rate of caregiver distress in B.C. when we look at the population these family members are caring for. B.C. has the oldest and most frail home support population in the country. Some positive news is that this year showed a drop in caregiver distress from last year, but there is still an overall increase over the past five years. We hope the data from this year signals a trend and that may be possible given recent government commitments to increase supports to caregivers,” said Mackenzie.
“Seniors at Home and in Long-Term Care, a 2017/2018 Snapshot” studies data released by the Canadian Institute for Health Information (CIHI) on the health status for 32,000 people receiving home support services and 34,000 people living in a subsidized residential care facility.
Key findings for the home care population include:
• At 80.5 years, B.C. has both the oldest and most frail home care clients in the country, with an 8.2% higher rate of frailty than the Canadian average (this rate has increased by three per cent in the last five years).
• B.C. Home Care Clients have a 26.4% higher rate of dementia although a 19.7% lower rate of moderate to severe dementia and the prevalence has dropped by 4% in the last five years, 2.1% of this achieved in this last year.
• Despite higher need, B.C. home care clients are more medically stable, with 32.4% showing no signs of health instability, compared with 22.1% nationally.
• Homecare clients in B.C. had a 45% higher rate of renal failure ( total of 13.2% of the clients)

• The province has the second highest rate of home care clients prescribed an antipsychotic in the country at 14.3%, 17.2% above the Canadian average.
• 23.7% of clients have diabetes, a rate similar to the national average.
• B.C.’s rate of clients showing signs of depression has risen 10.3% in the last five years, but is still 13% lower than the national average. Signs of depression are found in 21.4% of B.C. clients, versus 24.6% nationally.

There were 34,251 residents of publically funded long-term care home assessed in 2017/2018 and key findings include:
• Despite higher rates of dementia in B.C. care homes (3.9% higher), the rate of moderate to severe cognitive impairment is 3.8% lower in B.C. In total at 64.4% of residents have dementia and this has increased 4.8% in the last five years.
• Notwithstanding the dementia data, B.C. long-term care homes appear to have healthier residents compared to the national average, B.C. long-term care home residents have a 33.2% lower rate of arthritis, 24.8% lower rate of signs of depression and 16.3% lower rate of heart and circulatory disease.
• B.C. residents have a 16.9% lower rate of aggressive behaviour than the national average at 34.4% versus 41.4%, although B.C.’s rate has increased 2.1% over five years.
• B.C. residents are 16.1% more likely to be assessed as having limited or no social engagement compared to the national average, 50.6% versus 43.6%, but this has decreased by 4.9% over five years.
• B.C. LTC residents are 70.8% less likely to be on oxygen therapy (2.1% vs 7.2% nationally)
• B.C. LTC residents are 72% less likely to be monitored for an acute condition (8% in B.C. compared to 28.7% nationally).

“We see residents in B.C. long-term care homes appear to have less acute needs than the national average, however the trends are indicating this is changing.” said Mackenzie. “We want to ensure we are providing support as those needs increase, and understanding the unique challenges faced by our province when it comes to caring for a frail, elderly population.”
The full report can be viewed at