Resident and family member 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 and a risk that they can cause significant side effects such as confusion, dizziness and stroke, or even death.

CFHI is working with long term care organizations to expand access to person-centred dementia care by spreading and scaling the appropriate use of antipsychotics (AUA) approach across the country.

The Appropriate Use of Antipsychotics (AUA) Approach is a person-centred approach1 to care that engages people living with dementia, their families, and staff to understand the causes of behaviour and underlying issues (such as pain) and respond to an individual’s unmet needs based on their personal history.

Residents benefit from having their medications reviewed and appropriately discontinued or reduced if they are no longer needed, reducing their risk of negative health outcomes; this approach can also improve their care experiences and lives.

Rates of potentially inappropriate antipsychotic use are declining across Canada thanks to the efforts of providers, provincial health quality councils, governments, associations, and many others who are expanding appropriate use of antipsychotics programs: in 2013-14, about 1 in 3 long term care residents who did not have a psychosis diagnosis was prescribed an antipsychotic and by 2017-18, that number had dropped to 1 in 5.


How we started

AUA had its roots in CFHI’s EXTRA: Executive Training Program. Two managers, , Cynthia Sinclair and Joe Puchniak, from the Winnipeg Regional Health Authority designed an initiative to help multidisciplinary teams of healthcare providers better use data from the Resident Assessment Instrument/Minimum Data Set. The goal was to identify patients who may benefit from non-drug therapies to treat behavioural issues associated with dementia. At one site, staff were trained to provide non-pharmacological approaches to managing behaviours associated with dementia. As a result:

At one site, staff were trained to provide non-pharmacological approaches to managing behaviours associated with dementia. As a result:

  • 27% of a cohort of residents was taken off antipsychotic medication without any increase in behavioural symptoms,
  • Life experience and lives were improved for patients, and
  • A $400,000 savings was achieved across in six months across the region.

Where are we spreading and scaling the AUA collaborative?  

CFHI Appropriate Use of Antipsychotics Timeline

How does the AUA collaborative work?

CFHI provides tailored learning and coaching to help interprofessional teams in long-term care homes — nurses, personal care workers, physicians, pharmacists, administrators, and all staff — to use data to identify patients who may benefit from non-drug therapies to treat behaviours related to dementia. Equipped with better information about each resident, staff work together with residents and families to devise and provide person-centred approaches to care that make the resident feel safe and comfortable. This can include offering therapies and recreational activities that are meaningful and enjoyable, like pet and music therapy. This also provides an opportunity to create supportive environments that respond to resident needs and improve their comfort.

The AUA Approach

Appropriate use of antipsychotics in Canada infographic

Resources

CFHI has developed and curated others 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.


1 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.

Last Updated: November 2019