Appropriate use of antipsychotics in Canada. Elderly male patient with his pet bird. Across Canada, 1 in 5 long term care (LTC) residents is on antipsychotic medication without a diagnosis of psychosis. — 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.

The good news is that the rate of residents in long term care who have been prescribed an antipsychotic without a diagnosis of psychosis are falling in Canada thanks to the efforts of provincial health quality councils, governments, associations, providers and many others who are expanding appropriate use of antipsychotics (AUA) programs.

AUA is a person-centred approach to care that engages all staff, along with the resident’s family, to develop approaches to care that considers the preference of the resident and understand what triggers behaviours and provide more personalized care.

At CFHI, we’re doing our part to improve elder care by incubating, spreading and scaling the AUA approach across Canada.

How we started

The antipsychotics reduction collaborative had its roots in CFHI’s EXTRA: Executive Training Program. Two managers with 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:

  • 27% of a cohort of residents was taken off antipsychotic medication without any increase in behavioural symptoms,
  • Quality of life was 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 it work? 

CFHI provides tailored learning and coaching to help interprofessional teams in LTC homes — nurses, personal care workers, physicians, pharmacists and administrators — 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, direct care staff can then 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.

The AUA Approach

Appropriate use of antipsychotics in Canada infographic

Last Updated: February 2019