Appropriate Use of Antipsychotics

People taking antipsychotic medications can experience significant side effects, including confusion, dizziness, stroke or even death. However, if their clinical assessment suggests it is appropriate, people can use safer options that don’t include medications. 

The Appropriate Use of Antipsychotics (AUA) approach focuses on leveraging person-centered approaches to care as a means to deprescribing antipsychotics that no longer benefit and potentially cause harm for people living with dementia. Research shows this can improve the person’s quality of life and safety, providers’ work–life balance, and family and care partners’ satisfaction. 

The foundation of the AUA approach is providing a supportive care environment for the person with dementia; getting to know them and tailoring care to their habits and preferences. By regularly investigating possible causes for their negative personal expressions or behaviours, carers can try to resolve any unmet needs they may have. Such person-centred care is usually the most successful way to decrease or stop negative personal expressions or behaviours. 

The image above shows you how to use the AUA approach to care in practice: conduct medication reviews; practice person-centred approaches to care; partner with interprofessional staff, patients and families; apply deprescribing guidelines; and collect and monitor data.  

HEC first identified the AUA approach through our EXTRA: Executive Training Program. We then 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 New Brunswick, Newfoundland and Labrador, Prince Edward Island and Quebec. We have 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 AUA approach. In 2013-14, about one in three long-term care residents who did not have a diagnosis of psychosis were 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, we have 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. These resources focus on supporting the implementation of supportive care environments and safely deprescribing antipsychotics.    

Everyone involved in dementia care can learn about more effective ways to address negative personal expressions and behaviours from these tailored resources other than prescribing antipsychotic medications: 

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

The Collaboratives 

• Newfoundland and Labrador and Prince Edward Island 
• New Brunswick 
• Integrated approach for optimal use of medication in long-term care centres in Quebec (OPUS-AP – PEPS)

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. 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;/