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.

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:

• For people living with dementia, their families and care partners
• For health care leaders
• For prescribers

The Collaboratives

• Newfoundland and Labrador and Prince Edward Island
• New Brunswick
• Optimizing Practices, Uses, Care and Services - Antipsychotics (OPUS-AP) - Quebec