New National Results: Taking seniors off antipsychotics shows dramatic improvement in care

56 Canadian long term care homes slash use of inappropriate medication

Ottawa, Ontario– May 16, 2016 – The Canadian Foundation for Healthcare Improvement (CFHI) today released dramatic results from a bold pan-Canadian initiative reducing the inappropriate use of antipsychotic medication among seniors in long term care (LTC) – fewer falls, less aggressive behaviours and resistance to care, and an improved quality of life for residents and their families.

From 2014-2015, CFHI worked with 56 LTC homes that agreed to take senior residents off any antipsychotics that weren’t appropriately prescribed.

“Antipsychotics are often used in patients with dementia to curb resistance to care and other challenging behaviours,” says Stephen Samis, Vice President, Programs, CFHI. “But they provide limited benefit and can cause serious harm and complications from overuse – especially falls, which ultimately lead to unnecessary visits to the emergency room. With this initiative to reduce use, LTC providers report improved care for residents and a better culture at their facilities. Most important, family members say they now have their loved ones back.”

After only one year, early results from a sample of 416 residents from the facilities showed:

  • 54% of residents had antipsychotics discontinued or significantly reduced (18% reduced; 36% complete eliminations).
  • Among these residents:
    • Falls decreased by 20% .
    • Verbally abusive behaviour decreased by 33%
    • Physically abusive behaviour decreased by 28%
    • Socially inappropriate behaviour decreased by 26%
    • Resistance to care decreased by 22%

    “A major concern of removing the antipsychotic medication was the potential of increasingly aggressive behaviour. Aggression is what typically triggers the use of antipsychotics in the first place. Our initiative not only showed a notable decrease, it took that issue off the table,” says Samis.

    Five-year Forecast
    Recent studies show that more than one-in-four (27.5%) seniors in Canadian long term care facilities is on antipsychotic medication without a diagnosis of psychosis. If the results of the CFHI initiative were scaled up nationally, over the first five years an estimated:

    • 35,000 LTC residents per year would have their antipsychotics reduced or discontinued.
    • 25 million antipsychotic prescriptions would be avoided altogether
    • 91,000 falls would be prevented
    • 19,000 ER visits would be prevented (an 8% decline)
    • 7000 hospitalizations would be prevented (an 8% decline)

    “CFHI projections also show $194 million saved in direct healthcare costs – even after the costs of implementing the program are taken into account,” says Samis.

    Troubling Provincial Picture
    Also, there is a troubling discrepancy across jurisdictions concerning the use of antipsychotics in LTC without a diagnosis of psychosis. Only six Canadian provinces and territories publicly report on potentially inappropriate use of antipsychotics in LTC through interRAI™ – a health information system that uses common measures to support high quality care. That ranges from a low of 21.1% of people in Alberta LTC homes to nearly double that in Newfoundland.

    Potential Inappropriate Use of Antipsychotics in LTC – 2014-15

     Canada – National Average  27.5% 
     Alberta  21.1%*
     British Columbia  31.2%*
     Manitoba  Data Not Available**  
     New Brunswick  Data Not Available**
     Newfoundland/Labrador  38.2%*
     Northwest Territories  Data Not Available**
     Nova Scotia  Data Not Available**
     Nunavut  Data Not Available**
     Ontario  27.3%*
     PEI  Data Not Available**
     Quebec  Data Not Available**
     Saskatchewan  31.3%*
     Yukon  27.5%*

* Total provincial-territorial coverage for interRAI™ LTC data is available
** Total provincial-territorial coverage for interRAI™ LTC data is not available

“Some provinces such as British Columbia and Alberta have introduced their own antipsychotic reduction strategies, however across the country there is still room for improvement,” says Maureen O’Neil, President, CFHI. “Across Canada we have a patchwork quilt of care for people with dementia owing to tremendous variation in the use of antipsychotics.”

Available health evidence shows that 5-15% of seniors in long term care facilities should be on antipsychotic medication, yet the national average is much higher.

“There is a growing awareness of the inappropriate use of these strong medications and we have demonstrated that better care is possible,” says O’Neil. “Now is the time for bold action to ensure all Canadian seniors benefit from these antipsychotic medication reduction programs.”

CFHI is calling for:

  • Long term care homes and provincial-territorial governments to step up efforts to change the culture of over-medicating seniors with dementia, and increase access to alternate behavioural support programs.
  • Healthcare providers to take better patient histories, conduct more regular medications reviews and work as care teams with family members.
  • Frontline staff in LTCs to tailor services – including music, pet or recreation therapy that replace strong medications – to support quality of care and quality of life for residents.

Additional Information:
RiskAnalytica Report

Atlantic Canada
Ontario / Quebec
Western Canada

About the Initiative:
Supported by CFHI, 56 long term care facilities across seven Canadian provinces and one territory significantly reduced the inappropriate prescribing of antipsychotic medication. Interprofessional healthcare teams used patient-centered, data-driven approaches to managing the disruptive behaviours that can be associated with dementia. CFHI provided the teams with training, funding, expert coaching and a platform for peer to peer learning.

About CFHI
The Canadian Foundation for Healthcare Improvement identifies proven innovations and accelerates their spread across Canada, improving patient care, the health of Canadians and value-for-money. These innovations could save healthcare budgets over $1 billion per year. CFHI is a not-for-profit organization funded by Health Canada. Visit for more information.

The views expressed herein do not necessarily represent the views of Health Canada

To arrange media interviews, please contact:

  • Elissa Freeman – 416.565.5605
  • Robyn McIsaac (Maritimes) – 902.440.1551
  • Brigitte Filiatrault (Quebec) – 514.521.8216
  • Holly Roy (Western Canada) – 780.991.2323

Joel Baglole
Senior Communications Specialist
Canadian Foundation for Healthcare Improvement
C: 613-797-6481