Yukon launches project to improve dementia care

The Yukon is piloting a project to improve care for people with dementia living in the territory's continuing care homes. Reagan Gale is Yukon’s director of clinical psychology for continuing care.

The Yukon is piloting a project to improve care for people with dementia living in the territory’s continuing care homes.

Reagan Gale is Yukon’s director of clinical psychology for continuing care, a position newly created when she moved to the territory last year.

She said she has been enormously impressed with the level of care here in the Yukon.

“I’ve been really overwhelmed with the quality and dedication of our staff, and that’s not just lip service. I’ve seen remarkable, remarkable things.”

She recently saw one doctor spend more than an hour and a half on a patient visit with a continuing care resident, she said.

“I personally have never seen that kind of engagement.”

The project will involve training all staff at continuing care facilities to treat patients with dementia better, right down to the maintenance workers. That training has already begun.

“We had a gentleman who works on the heating and air systems, and he says he spends most of the time in the ceiling,” said Gale. “He did the training. The idea is, we want to capture everybody. Anybody who has the potential of interacting with any resident at any level.”

The other part of the project involves identifying patients who are being prescribed anti-psychotic medications who maybe should not be.

Anti-psychotics are supposed to be given to treat hallucinations and delusions.

Hallucinations are when you sense something that is not there.

That might include hearing voices, seeing things or feeling something crawl on your skin, said Gale.

Delusions are when you believe something to be true that is not based in reality.

They can be funny and pleasant or they can be distressing, said Gale.

For example, someone with a delusion might say, “Brad Pitt, he’s madly in love with me and he’s just with Angelina because he has to pretend to love her but he’s really in love with me,” said Gale.

Or they might say, “Brad Pitt is going to kill me. And I know Brad Pitt is going to kill me. It’s just a question of when he gets to the Yukon, then I know I’m dead.”

About 30 per cent of Yukon’s continuing care residents have a prescription for an anti-psychotic, in line with the national average, said Gale.

“How many of those residents have delusions and hallucinations? We know it’s less than 30 per cent.”

Patients are often prescribed an anti-psychotic in a time of crisis, said Gale. For example, maybe they are delirious with a high fever due to a bladder infection and start acting out at staff, who need to control that behaviour in order to treat the illness.

After the infection clears they may not need the medication any more, but there can be a reluctance to take them off of it, said Gale.

Family members might say, “I’ve never seen Mom behave that way. She’s not that person. I’ve never seen her yelling and fighting. If it’s the medication that’s keeping her from behaving like that, keep her on the medication,” said Gale.

But anti-psychotics have major side effects, and should not be used where they are not needed for hallucinations or delusions, she said.

They can be very sedating, and come with increased risks of heart attack, stroke, falls and death, especially in older patients, said Gale.

The plan is to identify a handful of Yukon continuing care residents who might be good candidates for slowly reducing anti-psychotic meds, and see how they do.

That would be done with the doctors, nurses, staff, family and patient all working together, said Gale.

If someone doesn’t do well on the lower dose, they would likely be raised back up to what they were on before, she said. But if their behaviour does not get worse, it’s probably an indication that the medication wasn’t doing much good for them.

This experiment has already been working in some facilities in Manitoba and Alberta, said Gale.

There, in most cases, behaviour didn’t get worse as patients were gradually taken off anti-psychotics.

Now Yukon is one of 15 jurisdictions selected from around the country where that work is being expanded.

The idea is to support the medication changes with care that focuses on treating people, not illnesses, said Gale.

That means adapting care to a person’s habits, needs and feelings, rather than fitting them into an institutional box.

For example, there was a man at a facility Outside who would pace at night, and staff prescribed anti-psychotic medication to help him calm down and get to sleep, said Gale.

But when they talked to his family, they learned that he was always a night owl. He would watch TV or tinker in the tool shed till 1 or 2 a.m., have a bowl of oatmeal and sleep the rest of the night.

So staff at the facility adapted to his habit, allowed him to be up and about at night and prepared a bowl of oatmeal for him at 1 a.m.

The medication was no longer needed.

Yukon’s continuing care facilities are very well-resourced compared to the rest of the country, and Gale is confident that this work will result in long-term policy and procedure changes that improve care, she said.

“I see this initiative as being totally self-sustaining,” said Gale.

“We already have everything in place to make it happen, it’s just a matter of starting conversations.”

Contact Jacqueline Ronson at

jronson@yukon-news.com

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