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One in four long term care residents in Canada is on antipsychotic medication without a diagnosis of psychosis. Although antipsychotics are commonly prescribed to treat behavioural symptoms of dementia, these medications are minimally effective in managing behavioural issues and are associated with worsening cognitive function.

Choosing Wisely Canada and the Canadian Geriatrics Society have recommended that in most cases, antipsychotics should not be the first choice for treatment. Non-pharmacological, patient-centred approaches should be used as a first line approach.

Appropriate Use of Antipsychotics (AUA)

The AUA Approach is a person-centred model of care that involves teams of direct care staff and clinicians working together with families to replace antipsychotic drugs with personalized resident care, such as music and recreation therapy.

In May 2014, CFHI designed and launched its first pan-Canadian AUA collaborative, working with 56 long term care homes – in seven provinces and one territory – to cut the inappropriate prescribing of antipsychotic medication to seniors residing in long term care.

This collaborative had its roots in an innovation implemented through the EXTRA: Executive Training Program.

Results were impressive: after only one year of the collaborative, 54% of residents had antipsychotics discontinued or significantly reduced. There were also decreases in decrease in falls, resistance to care, and socially inappropriate behaviour.

The positive results led to the first provincially funded and supported CFHI-AUA scale collaborative, in New Brunswick. This initiative is now spreading and scaling up across all nursing homes in the province.

 

Resources

Impact Stories and Improvement Conversations

Tool

  • CIHI’s web tool Your Health System compares health systems across the country with one another. In 2015, CIHI released new performance indicators that included Potentially Inappropriate Use of Medication in Long-Term Care, a measurement now also being used by CFHI to track improvements in resident care.