Appropriate Use of Antipsychotics

More than 78,000 people in Canada aged 65 and older are newly diagnosed with dementia every year.1 Often people living with dementia are prescribed antipsychotic medications to help manage their negative personal expressions or behaviours.

Antipsychotic medications can cause significant side effects, including confusion, dizziness, stroke or even death. Safer options that don’t include medications are available.

The Appropriate Use of Antipsychotics approach focuses on deprescribing antipsychotics that no longer benefit and potentially cause harm for people living with dementia. This has been shown to improve a person’s quality of life and safety, the work-life of providers and satisfaction of family and care partners.

The foundation of the Appropriate Use of Antipsychotics approach is to provide a supportive care environment. Getting to know the person and tailoring care to their habits and preferences. And regularly investigating possible causes for negative personal expressions or behaviours, to meet any unmet needs they may have. This type of care usually works best to decrease or stop negative personal expressions or behaviours.

 

AUA Infographic

This image describes components of the AUA approach to care: apply deprescribing guidelines; collect and monitory data; conduct medication reviews; practice person-centred approaches to care; engage interprofessional staff and families.

The Appropriate Use of Antipsychotics approach was first identified through Healthcare Excellence Canada’s EXTRA: Executive Training Program. Healthcare Excellence Canada partnered with long-term care homes and provinces across Canada to spread the approach, first through a national collaborative, and then through provincial collaboratives in Quebec, New Brunswick, Newfoundland and Labrador and Prince Edward Island. Healthcare Excellence Canada has supported more than 300 long-term care homes to safely deprescribe antipsychotics for people living with dementia.

Rates of potentially inappropriate antipsychotics use are declining across Canada thanks to efforts like the Appropriate Use of Antipsychotics approach. In 2013-14, about one in three long-term care residents who did not have a diagnosis of psychosis was prescribed an antipsychotic.2 By 2017-18, that number had dropped to one in five.3

In partnership with organizations including Choosing Wisely Canada and Canadian Deprescribing Network, Healthcare Excellence Canada has developed and curated improvement resources to help long-term care staff and essential care partners provide the best care and support for people living with dementia, including through implementing supportive care environments and safely deprescribing of antipsychotics.   

Specific resources are available to inform everyone involved in dementia care about more effective ways to address negative personal expressions and behaviours, than prescribing antipsychotic medications:

The Collaboratives

Improvement Conversation

OPUS-AP, a Powerful Driver for Improving Quality of Life in Long Term Care Facilities
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News Release

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

Tool / Resource

Appropriate Use of Antipsychotics Resources
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1 Public Health Agency of Canada. (2019). A Dementia Strategy for Canada: Together We Aspire. Retrieved from: https://www.canada.ca/content/dam/phac-aspc/images/services/publications/diseases-conditions/dementia-strategy/National%20Dementia%20Strategy_ENG.pdf 

2 Canadian Institute for Health Information. (2016). Use of Antipsychotics Among Seniors Living in Long-Term Care Facilities, 2014. Ottawa, ON. Retrieved from https://secure.cihi.ca/free_products/LTC_AiB_v2_19_EN_web.pdf 

3 Canadian Institute for Health Information [online]. Potentially Inappropriate Use of Antipsychotics in Long-Term Care. Retrieved from: https://yourhealthsystem.cihi.ca/hsp/inbrief#!/indicators/008/potentially-inappropriate-use-of-antipsychotics-in-long-term-care/;mapC1;mapLevel2;/