New Results: Innovative program is improving lives of seniors with dementia in Newfoundland & Labrador and Prince Edward Island

November 13, 2019 (St John’s) -Today, the Canadian Foundation for Healthcare Improvement (CFHI), the Government of Newfoundland and Labrador, and Health PEI announced the results of a successful collaboration to appropriately reduce the use of antipsychotic medication among people with dementia who are living in long term care organizations in Newfoundland and Labrador and Prince Edward Island.

More than half of participating residents in Newfoundland and Labrador and Prince Edward Island prescribed antipsychotics without a diagnosis of psychosis had these medications safely reduced or discontinued. This improves their care experiences and lives while also reducing the risk of negative health outcomes.

The Appropriate Use of Antipsychotics (AUA) is a person-centred approach1 to care that engages people living with dementia, their families and staff to understand the causes of behaviours and underlying issues (such as pain), and respond to an individual’s unmet needs based on their personal history. The approach involves reviewing the appropriateness of antipsychotic medication and creating individualized care plans with alternative activities that are meaningful and enjoyable, like exercise, pet or music therapy. This also provides an opportunity to create supportive environments that help the person to feel calm, safe, and comfortable.

The final results of the collaboration include:

  • In Newfoundland and Labrador, 52 percent of residents2 who were prescribed antipsychotic medication, but did not have a psychosis diagnosis, had their medication reduced or discontinued (30 percent discontinued, and 22 percent reduced dose)
  • In Prince Edward Island, 53 percent of residents2 who were prescribed antipsychotic medication but did not have a psychosis diagnosis had their medication reduced or discontinued (25 percent discontinued, and 28 percent reduced dose)
  • No change in physical or verbal aggressive behaviours among these residents.

The results were announced at a workshop in St John’s with the participating teams from the two provinces. The teams now have the opportunity to join the Momentum Challenge – an invitation-only CFHI program that assists teams to expand the reach of an innovation and sustain its impact.

The collaboration to expand person-centred dementia care and the appropriate use of antipsychotics began in January 2018 involving all 39 publicly-funded long term care homes in Newfoundland and Labrador, all nine publicly-funded homes in Prince Edward Island, and five from the Seniors Quality Leap Initiative – a North American network of long term care organizations focused on improving clinical care and safety for seniors.

There are more than 419,000 Canadians aged 65 and older diagnosed with dementia; and more than 78,000 new cases diagnosed every year among this age group. 3 Antipsychotic medications are often used to help manage behaviours related to dementia in long-term care, for example agitation and aggression. However, there is a lack of evidence to support their effectiveness for people who do not have a diagnosis of psychosis and a risk of significant side effects such as confusion, dizziness and stroke or even death.

Through province-wide expansion in Quebec, New Brunswick, Newfoundland and Labrador and Prince Edward Island, CFHI has supported more than 300 teams to provide more person-centred dementia care and reduce potentially inappropriate antipsychotic use.

CFHI and partners have developed resources and tools to support people and organizations to better understand the use of antipsychotic medications, have conversations about their appropriate use, and support long term improvements in person-centred approaches to care. These free resources are available on the CFHI website and include resources from the Canadian Patient Safety Institute, Choosing Wisely Canada and Alzheimer’s Society of Canada.

For a full list of participating long term care organizations and regional results, visit https://www.cfhi-fcass.ca/sf-docs/default-source/collaborations/aua-nfld-pei-backgrounder-e.pdf.

Quotes

“We are very pleased with the progress to date, and would like to thank the families and staff of all our long term care homes throughout the province for their commitment to the appropriate use of antipsychotics‎ collaborative. Their commitment, and the support from CFHI, has resulted in improvements in care and quality of life for people living in long term care. While this project has concluded, our commitment to improving outcomes in this area will continue,” said the Honourable John Haggie, Minister of Health and Community Services, Government of Newfoundland and Labrador.

“We are very proud of how the long term care homes have fully embraced this approach to care and we congratulate them on their commitment and leadership,” said Andrew MacDougall, Director of Long-Term Care, Health PEI. “We will be working with private long term care homes to expand the reach of the AUA approach.”

David Clothier’s wife, Madonna, is a resident at Bay St George in Newfoundland and Labrador. Through the AUA approach, Donna has had her antipsychotic medication successfully reduced. “Madonna was like someone living in a fog and after her medication was reduced, she came out of that fog” said Mr. Clothier. “Donna started putting out her hand for me to take, we now walk almost every day. She is more receptive to other people and interacts with staff and other residents.”

“We’re delighted to celebrate the leadership of Newfoundland and Labrador and Prince Edward Island in improving care for people living with dementia,” said Jennifer Zelmer, President and CEO of CFHI. “Their efforts will help to accelerate national declines in potentially inappropriate antipsychotic use. In 2013-14, about one in three long term care residents who did not have a psychosis diagnosis were prescribed an antipsychotic. By 2017-18, that number had dropped to one in five.”

Patient Stories

For more information: http://www.cfhi-fcass.ca/WhatWeDo/appropriate-use-of-antipsychotics 

Mr David Clothier with his wife and Bay St. George Long Term Care Centre resident Mrs Madonna Clothier

Taking daily walks together
Mr David Clothier with his wife and Bay St. George Long Term Care Centre resident Mrs Madonna Clothier


About the Canadian Foundation for Healthcare Improvement

The Canadian Foundation for Healthcare Improvement works shoulder-to-shoulder with partners to accelerate the identification, spread and scale of proven healthcare innovations. Together, we’re delivering lasting improvement in patient experience, work life of healthcare providers, value for money and the health of everyone in Canada. CFHI is a not-for-profit organization funded by Health Canada. Visit cfhi-fcass.ca for more information.
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The views expressed herein do not necessarily represent the views of Health Canada.

For more information, or to arrange media interviews, please contact:
Graeme Wilkes, Senior Director, Communications and Government Relations
Canadian Foundation for Healthcare Improvement
Mobile: 613-698-7538 | Graeme.Wilkes@cfhi-fcass.ca 


In this context, person-centred approach refers to a way of thinking and improving care where the people using healthcare services are equal partners in planning, developing and monitoring care and ensures it meets their needs.

2 Of those still participating in the program at the end of Phase 1 and Phase 2.

3 Public Health Agency of Canada. A Dementia Strategy for Canada: Together We Aspire. 2019. Available from: https://www.canada.ca/content/dam/phac-aspc/images/services/publications/diseases-conditions/dementia-strategy/National%20Dementia%20Strategy_ENG.pdf