Rate of antipsychotic use is rising in long-term care homes in Canada

A new report by the Long-Term Care Subgroup of the Appropriate Use Coalition has discovered that nearly 25% of long-term care (LTC) residents in Canada are receiving antipsychotic medications that are potentially inappropriate. The report was prepared using the latest data from the Canadian Institute for Health Information. It highlights inappropriate antipsychotic use in LTC homes, with rates rising since the onset of the COVID-19 pandemic, reaching 24.5% in 2023–24.1Antipsychotics are frequently used inappropriately in Canadian LTC homes—often as the first choice to manage aggression associated with dementia, and behaviours associated with resisting care in older adults who are not experiencing psychosis. Prescribing antipsychotics without addressing the root causes of these behaviours or exploring nondrug alternatives raises questions about the safety and quality of care in LTC homes. Antipsychotic medications carry significant risks, including increased risk of stroke, falls, fractures and even death.1 Some key points raised in the Coalition’s report are summarized below:In the years prior to COVID-19, the percentage of LTC residents on antipsychotics without a diagnosis of psychosis had decreased from 27.2% in 2014–2015 to 20.2% in 2019–2020 due to significant efforts to address the behavioural and psychological symptoms of dementia by other means. However, since the onset of COVID-19, antipsychotic use has been rising, climbing to 24.5% in in 2023–24, and reversing much of the progress made in the past decade.While the overall rate of antipsychotic use in LTC homes in Canada was 24.5% in 2023–2024, most reporting provinces and territories were well above the national average: Yukon (35.3%), Saskatchewan (34.8%), New Brunswick (33.7%), Newfoundland/Labrador (31.8%), British Columbia (29.3%) and Nova Scotia (29.3%). Only Alberta (22.5%) and Ontario (20.5%) fell below the national average.The rate of antipsychotic use in individual LTC homes varied widely. The 150 LTC homes in the 10th percentile had an antipsychotic use rate of ≤ 10.5%, while the rate in the 150 homes in the 90th percentile was ≥ 40.8%.1The Coalition’s report includes a searchable table providing the 2023–2024 rates of potentially inappropriate use of antipsychotics for 1,500 LTC homes in Canada for which data are available.1 Overall, the report stresses that antipsychotic use in LTC homes in Canada is heading in the wrong direction. One of the reasons may be that LTC homes are facing considerable staffing shortages and high turnover, which makes it more challenging to implement quality improvement initiatives.1 The report urges a coordinated approach to get Canada back on track. The recently created Appropriate Use Coalition consists of 11 Canadian healthcare organizations with expertise in various aspects of appropriate drug use.2 The member organizations of the Coalition are working collaboratively to improve appropriate prescribing and use of medications in Canada. The Coalition’s Long-Term Care Subgroup prepared the current report on antipsychotic use in Canada's LTC homes. The Subgroup is specifically working to address appropriate use of antipsychotics in LTC, including the development of quality improvement programs and critical tools and resources. The following seven groups comprise the Long-Term Care Subgroup: Canadian Institute for Health Information; Canadian Medication Appropriateness and Deprescribing Network; Choosing Wisely Canada; deprescribing.org; Healthcare Excellence Canada; Institute for Safe Medication Practices (ISMP) Canada; and RxFiles.1Earlier this year, the Canadian Coalition for Seniors’ Mental Health published Canadian clinical practice guidelines for assessing and managing the behavioural and psychological symptoms of dementia (BPSD) for use in community, outpatient, inpatient and LTC settings. The guidelines focus on management of five major BPSD: agitation; psychosis (including delusions and hallucinations); depressive symptoms and depression; anxiety; and sexual expressions of potential risk. The guidelines also provide recommendations for deprescribing of antipsychotics and other medications frequently used in the management of BPSD.3References:Appropriate Use Coalition, Long-Term Care Subgroup. Rising rates. Antipsychotic use in Canada's LTC homes. (accessed December 19, 2024).Canada’s Drug Agency. Organizations unite to improve the appropriate use of medications in Canada. December 2, 2024. (accessed December 19, 2024).Canadian Coalition for Seniors’ Mental Health. Canadian clinical practice guidelines for assessing and managing behavioural and psychological symptoms of dementia (BPSD). Toronto, ON; 2024. (accessed December 19, 2024).

Rate of antipsychotic use is rising in long-term care homes in Canada

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