"Sometimes it's very difficult for a person with dementia to get their thoughts across, then they get agitated and upset," said Dr. George Heckman, associate professor at the University of Waterloo and Schlegel Research Chair in Geriatric Medicine in a recent interview. "They have behaviours that are very difficult, sometimes, to manage, and when that happens you need a lot of specialized work to be done. Unfortunately we just do not have the resources."
In what Ontario mental health experts are describing as a worsening trend, dementia patients are being increasingly assigned to hospital beds reserved for psychiatric patients. According to the latest data from the Canadian Institute of Health Information, a third of all psychiatric beds in Ontario hospitals are being filled by dementia patients, largely due to a shortage in regular hospital beds and long-term health care facilities. Unfortunately, psychiatric treatment staff often lack the necessary training to diagnose dementia properly, let alone providing the necessary treatment. This means that dementia patients may end up receiving treatment that does more harm than good, including the overuse of psychiatric medications that may worsen their symptoms.
Since anti-psychotic drugs and major tranquilizers are frequently used as "chemical restraints" for agitated patients, being forced to take these medications can lead to adverse side effects as well as potentially dangerous drug interactions with other medications they are taking. Also, many dementia patients have additional medical problems such as coronary disease and hypertension which psychiatrists and mental health nurses may not be properly trained to treat. "I've never seen a person come back from a psychiatric admission with dementia who didn't have at least one other major psychotropic drug added or increased," said Dr. Allen Power of the University of Waterloo Research Institute for Aging .
Over the past ten years, psychiatric admissions for dementia patients has more than doubled in Ontario hospital as dementia becomes more prevalent in seniors. The current COVID-19 pandemic is expected to make the problem far worse due to the reduced number of beds available as well as the increased care needed by residents in long-term care facilities. Also, due to current pandemic control guidelines, care facilities are no longer allowed to house patients in close proximity to one another. That means that residents can no longer be placed in open wards but only in dedicated rooms that can only accommodate one or two residents at a time. Even before the pandemic began, the average time patients needed to wait for a spot in a long-term care home can be as long as a year or more. While the average wait time across the province is around ninety days according to Health Quality Ontario , this will certainly soar since the number of dementia patients is expected to double by 2038.
Tying up psychiatric beds with dementia patients also means fewer beds being available for people experiencing mental health crises or who are actively suicidal. And having been in a psychiatric hospital may actually reduce the likelihood of getting a long-term care bed for many patients. Though there are hospitals such as Ontario Shores in Whitby, Ont., and Baycrest Centre in Toronto, that have created units to house such patients, these units lack the capacity to meet the current demand, not to mention the increased demand will will be seeing in future.
For now, the lack of beds across Ontario, especially in smaller communities means that the problem will become far worse as hospitals and the provincial government continues to wrestle with this dilemma.
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