A new report reveals that one in four long-term care (LTC) residents in Canada may be on antipsychotic medications inappropriately. The report, Rising Rates: Antipsychotic Use in Canada’s LTC Homes, was prepared by LTC members of the Appropriate Use Coalition using the latest data from the Canadian Institute for Health Information (CIHI).

Antipsychotics are often prescribed as the first choice for managing behaviours associated with dementia such as aggression and resisting care. However, Canadian guidelines caution against their frequent use in older adults without a psychosis diagnosis, as the risks— increased likelihood of strokes, falls, fractures, and death—outweigh the benefits.

CIHI has been monitoring the use of potentially inappropriate antipsychotics in LTC homes for over a decade. While efforts to reduce inappropriate prescribing had shown progress prior to the COVID-19 pandemic, the latest data indicates a concerning reversal of this trend.

Key Findings:

• Percentage of LTC residents on antipsychotics without a diagnosis of psychosis decreased steadily from 27.2% to 20.2% between 2014-15 and 2019-20
• Rates have been on the rise since the onset of COVID-19, climbing to 24.5% in 2023-24
• Every reporting province and territory in Canada rose by at least 2% since the start of the pandemic, with the steepest rise in Newfoundland and Labrador at 8.7%
• Variation at the level of individual LTC homes among the 1,500 sites that reported antipsychotic use data ranged from zero to 86.3%

The report acknowledges the reasons for this rise are not entirely clear, but the pandemic likely exacerbated the conditions for their use. Significant staffing shortages and high turnover rates have also created systematic challenges in LTC, making it more difficult to implement improvement efforts than before.

The coalition is calling for a coordinated response to set national targets for the LTC sector in Canada, backed by improvement programs and tools to support individual homes. An expert panel has been convened to provide guidance on a national target, scheduled for release in mid-2025.

About the Appropriate Use Coalition

The Appropriate Use Coalition consists of 11 organizations that are working collectively to improve the appropriate prescribing and use of medications in Canada. The Long-Term Care Subgroup, responsible for the report, is working to address the specific issue of appropriate use of antipsychotics in LTC.

Appropriate Use Coalition – Long-Term Care Subgroup Members:

• ​Canadian Institute for Health Information
• Canadian Medication Appropriateness and Deprescribing Network
• Choosing Wisely Canada
• deprescribing.org
• Healthcare Excellence Canada
• Institute for Safe Medication Practices Canada
• RxFiles

The full report is available at: LTCmeds.ca