Assessing Therapeutic Recreation Attendance and Potentially Inappropriate Antipsychotic Use in Long-Term Care

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Date
2020-06
Authors
McKenzie, J. Rowen
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Mount Saint Vincent University
Abstract
Responsive behaviours are commonly expressed by persons living with dementia (PLWD) in long-term care (LTC) as a way of communicating an unmet need. One commonly reported unmet need amongst PLWD is the need for daytime activity. PLWD in LTC spend much of their time by themselves. Minimal opportunities for engagement or daytime activity in LTC may lead to the expression of responsive behaviours. Pharmacological and non-pharmacological interventions are often employed by health care professionals in LTC to mitigate or halt the expression of these behaviours. Despite their known risk of harm and evidence which supports the use of non-pharmacological interventions, antipsychotics continue to be administered to PLWD in LTC. The purpose of this research was to determine whether there was a correlation between therapeutic recreation (TR) attendance and potentially inappropriate antipsychotic (PIA) use in LTC homes in Alberta (AB) and Ontario (ON). It was hypothesized that there would be a negative correlation between TR attendance and PIA use in LTC. This study utilized secondary, aggregate (e.g., institutional level), unidentified data collected with the Resident Assessment Instrument -Minimum Data Set 2.0 (RAI-MDS 2.0) and obtained from the Canadian Institute for Health Information. This data set, titled Continuing Care Reporting System, 2018-2019, reflected RAI-MDS 2.0 assessments from the last fiscal year. Seven nested linear regression models were generated with the Statistical Package for Social Sciences to assess for a correlation between PIA use, TR attendance and other variables of interest. Analyses for significant interaction effects were also undertaken. A total of 303 LTC homes were included in this analysis (AB = 131, ON = 172). Within the total sample, the mean proportion of PIA use in a 7-day period was .19; rates of use were similar in AB and ON. The proportion of TR attendance within the total sample was low at .27. On average, TR was attended for 34.98 minutes or 0.73 days in a 7-day period. The mean proportion of TR attendance was significantly lower in ON (.13) than AB (.46). Responsive behaviours were commonly observe in LTC homes in both provinces. The proportion of dementia within the total sample was .50. Findings of the main linear regression model (N = 267) indicated that TR attendance (β = .145, p = .069), home size (medium vs. small [β = -.352, p = .002], large vs. small [β = -.460, p = .001]), and proportion of depression (β = -.208, p = .011) were significant predictors of PIA use in LTC. Several significant interaction effects were observed, including mean Aggressive Behaviour Scale scores and proportion of dementia. Results of this study support further inquiry into PIA use and the provision of social and leisure activities in LTC homes. Three suggestions are made for improving quality of life in LTC: (a) ensure the effective use of allied health professionals; (b) allocate funding for regular social and leisure activities; and (c) improve staffing ratios in smaller homes. These suggestions as well as recommendations for future research and policy implications are discussed.
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