By Elizabeth Benner
When you walk through the resident halls of Unity Health Toronto’s Cardinal Ambrozic Houses of Providence, each door tells a story.
The signs adhered to each resident’s door – ‘life stories’ as they’re called by the staff – within the long-term care home tell the story of the person inside – describing their families, their lives, and things they like to do.
The initiative came out of the early days of the COVID-19 pandemic, a scary time for the long-term care home. In an effort to protect the residents from the virus, the Houses, like many long-term care homes in Canada, had to limit visiting and in-person interaction for their residents. The result was a slight uptick in the use of antipsychotic medication to keep residents, who may be distressed, as calm as possible.
Dr. Ashley Verduyn, Medical Director at the Houses of Providence, turned to research led by her colleague at Unity Health Toronto, Dr. Jennifer Watt, a Geriatrician and Researcher at St. Michael’s. The two have begun to collaborate on research projects across Unity Health, their first project focused on applications for an award-winning study led by Dr. Watt at the Houses of Providence. The article was published in the Annals of Internal Medicine in October 2019, and suggested non-drug interventions led to more positive outcomes among patients with dementia displaying aggression and agitation.
“Residents with dementia can exhibit behaviours like restlessness, agitation and aggression that at times can make providing personal care difficult for staff. Some of these behaviours may have worsened during the pandemic due to isolation and the lack of family and caregiver presence due to visiting restrictions that were mandated,” Dr. Verduyn explains.
Dr. Jennifer Watt and Dr. Ashley Verduyn collaborated to implement Dr. Watt’s research at the Houses of Providence in order to improve resident mental health during the pandemic.
Moving residents off anti-psychotics was a priority for the team at the Houses. According to Dr. Watt’s study, patients with dementia who experience neuropsychiatric symptoms, such as aggression and agitation, are more likely to experience a lower quality of life and increased risk of death compared who patients who don’t experience those symptoms. This risk is further complicated due to the association of pharmacological interventions with more potential harms in this group of patients such as falls, fractures and death. Caregivers of patients who experience these symptoms also experience a lower quality of life.
The team implemented hand massages, life story reminiscing that resulted in signage posted on the residents’ doors, music therapy, and stuffed toy therapy (to replace therapy animals). Marnellie Hilao, the Behavioral Support Lead at Unity Health’s Houses of Providence, and her team found ways to engage the residents who were craving interaction: setting up a makeshift hair salon, taking residents on a walk, modifying games to reduce contact between residents.
“Slowly now we’re going back to normal,” Hilao says.
Although the applications of Dr. Watt’s paper were for patients living with dementia, she pointed out the observed statistical and emotional shifts when non-pharmacological methods were used for all residents at the Houses of Providence, not just those living with a particular illness.
“While our study is specific to those with dementia, the research has broader applications that an older patient’s behaviour has meaning and is potentially in response to something in their environment. I think that’s ultimately what it’s pointing to, that it’s trying to get to the underlying causes for those behaviours that older people are having,” Dr. Watt says. “I believe research should be used to help people and I’m really fortunate so early in my career to have been able to work with such wonderful people who feel the same way and who are really taking research and using it to for patient care so quickly.”
Since putting the research into practice, the number of residents receiving antipsychotics dropped from 28 per cent of residents to 19.4 per cent. Despite admitting more residents who were taking antipsychotics from other facilities during the pandemic, the Houses of Providence still managed to decrease their numbers.
“We’ve seen immediate effects in the emotional well-being of our residents. We also have lower rates than the provincial average in terms of residents with symptoms of depression,” Dr. Verduyn says.
“I’m so very proud of the Houses team for their hard work throughout the pandemic. I also feel very fortunate to be able to collaborate with experts like Dr. Watt in implementing evidence based initiatives like this that ultimately improve the quality of life for our residents.”
Elizabeth Benner is a communications intern at Unity Health Toronto