Dementia in long-term care

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The number of Canadians over the age of 65 is growing significantly and so is the number of seniors living with dementia in the country. While dementia is not a natural part of aging, the biggest risk factor associated with a diagnosis is age.  According to data published in Dementia in Canada, a new report by the Canadian Institute for Health Information (CIHI), it is estimated that the number of Canadians living with dementia will double over the next 20 years due to the aging population and population growth.

Seniors with dementia have complex care needs. About two-thirds of them live in the community—either at home, with a caregiver or in an assisted living facility—and they need considerable support from caregivers or formal home care services to do so comfortably.  As dementia progresses and care needs change, many will be moved into long-term care (LTC) facilities.

Challenges in care

CIHI’s report revealed that 69% of residents in LTC had dementia in 2015-2016. Symptoms of dementia, such as verbal and physical abuse and resisting care, can be challenging to manage. Severe cognitive impairment affected 40% of residents, 50% had responsive behaviours (such as verbal and physical abuse), 31% had signs of depression and 82% required extensive assistance or were dependent on assistance for activities of daily living.

Nancy Cooper, the Director of Quality and Performance at the Ontario Long Term Care Association said, “It’s a double challenge. In addition to managing behaviours, the loss of cognition in seniors with dementia means their loss of ability to walk or do activities of daily living. Many of the residents need to be fully supported with feeding, toileting, cleaning their mouth, dressing, etc. The most frequent challenging behaviour is refusing care.”

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To help manage some of the behaviours exhibited by residents (with and without dementia), LTC facilities sometimes turn to physical restraints (such as wheelchair lap belts or bed rails) or chemical restraints such as potentially inappropriate antipsychotic medications.

Restraint and antipsychotic use decreasing in LTC

The practice of using physical or chemical restraints in LTC is a controversial one, and over the last 5 years, we are starting to see notable decreases in their use.  This is largely attributed to policy changes and educational programs for staff that focus on person-centred care.

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Various policy changes have been rolled out across the country. Among them is Ontario’s Long-Term Care Act, which requires LTC homes to reduce the use of restraints (both chemical and physical) wherever possible. In response, Behavioural Supports Ontario (BSO) launched a team-based program in 2010. This program enhances health care services for Ontario’s seniors, their caregivers and their families who are living and coping with responsive behaviours associated with dementia and other illnesses.

On BSO, Cooper said, “[they] provided specific skill set training to a few staff in the LTC homes in Ontario. The staff became the in-house experts to spread the knowledge. They helped others to replicate what they do. Where these teams are embedded, everyone in the home is better adapted to manage the care of seniors living with dementia.”

The way forward

The downward trend of use of restraints and potentially inappropriate antipsychotics in LTC is a positive sign for residents and LTC staff alike. A person-centered approach means meaningful relationships are able to form between care-receivers and providers and this ultimately improves the quality of life for residents in their declining years.

CIHI regularly reports on the use of restraints and potentially inappropriate antipsychotics in the Your Health System: In Depth web tool to help inform health care decision makers on trends and steer evidence-based performance improvement.

This article was submitted by the Canadian Institute for Health Information.