Music to my ears

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In his twenties, Vernon Lutness was in a band called The Swing Four, playing at country dances around Camrose, Alberta. In his late sixties, before dementia took hold, he played with another band called The Jammers.

"He loved music and played several instruments by ear, including the guitar, piano and accordion. He taught me to dance," remembers his sister, Joan Jones. She would like to think still gets pleasure from the gift of music. And recent changes in his medications—and behaviour—suggest he just might.

Now 82, Vernon has lived at Capital Care Strathcona in Sherwood Park, Alberta, for 6 years. He has been in the secure long-term care unit for most of that time. "I was lucky to get him in there as I live very close by," notes Ms. Jones, who is 12 years younger than her brother and his legal guardian.

Vernon's transition to his new home went well. But after a minor altercation with another resident, changes seemed to set in quickly. "After he fell and broke his hip, he no longer walked and spent all his time in a wheelchair. Vern was sleeping a lot and not talking much," remembers Ms. Jones.

At an annual family conference, Ms. Jones discovered that her brother had been prescribed an antipsychotic medication several months before. She readily agreed to take him off the drug as part of a medication assessment trial under way at the centre.

"The change was absolutely amazing," says Ms. Jones. "Vernon was talking again, making little noises. Every now and then, he comes out with complete sentences—and they aren't all short ones!"

Vernon is one of dozens of residents who have benefitted from the data-driven initiative looking at the appropriate use of antipsychotic drugs. With support from the Canadian Foundation for Healthcare Improvement, work first began in the Winnipeg Health Region. Researchers used RAI data as a measurement and assessment tool to help monitor and reduce antipsychotic medication use in long-term care. Now, Alberta is also using RAI data as a key measurement and assessment tool for the provincial Appropriate Use of Antipsychotics in Long Term Care (AUA in LTC) project.

The project is resulting in improved patient care and better quality of life. Antipsychotic medications are moving from first-line treatment to one of last resort for residents who have dementia and exhibit responses that challenge staff and family.

The resident-centred approach encourages care providers to look broadly at residents' entire histories, not just their health history. Caregivers can then get creative and brainstorm other approaches to support these residents.

"We noticed that as Vernon began to vocalize and respond to his environment, we could communicate and respond back to him better. We got to know him as a person; as Vernon," notes Elizabeth Tanti, Administrator, CapitalCare Strathcona

Over the past 2 years, Ms. Jones has been continually amazed by the change in her brother. "He is out with the others in his wheelchair. Sometimes he talks and makes noises so much, he gets annoying," she laughs.

And then came the day when Ms. Jones and Vernon were sitting together listening to a visiting entertainer. "Out of the blue, Vern turned to me and said 'Thanks for visiting me today.' I burst into tears. His eyes were bright and I could tell he was listening to the music."

The In Brief section of CIHI's Your Health System web tool now compares data across provinces over a broad period of time. The usage rates of antipsychotic medication in long-term care homes in Alberta (25%) and Winnipeg (23%) have dropped over the past few years since the start of these initiatives. They are now among the lowest in Canada, well below the 30% national average.

This spring, CIHI will expand the In Depth section of Your Health System to report on antipsychotic indicators right down to the facility level—a first in Canada.

Ms. Jones says she hopes that her brother's story can help others. "He went for so long without saying anything that made sense, or anything at all. And now I feel as though Vern is still in there and I have a little bit of my brother back."