Rising Rates: Antipsychotic Use in Canada's LTC Homes

Over the past decade, long-term care (LTC) homes across Canada have made important progress in reducing inappropriate antipsychotic use. By using person-centered care strategies to address dementia-related behaviors, these efforts have achieved meaningful improvements in care quality, benefiting residents, care partners and care providers.

However, the COVID-19 pandemic brought significant challenges. Staffing shortages and high turnover rates have made it increasingly difficult to implement and sustain improvement efforts. Since 2020, rates of potentially inappropriate antipsychotic use have increased in many provinces and territories.

Rising Rates: Antipsychotic Use in Canada’s LTC Homes highlights the need to build on past successes and continue making progress on reducing the use of antipsychotics that no longer benefit and potentially cause harm for people living with dementia.

Key highlights from the report

• Nearly one in four residents in LTC homes may have been receiving antipsychotic medications inappropriately in 2023-24, according to newly released data from the Canadian Institute for Health Information (CIHI) that looks at rates across nine provinces and territories.

• The overall percentage of LTC residents on antipsychotics without a diagnosis of psychosis increased from 20.2% in 2019-2020 to 24.5% in 2022-2023. The rate held steady at 24.5 in 2023-2024.

• While the exact causes are unclear, factors such as staffing shortages and infection control measures during the pandemic likely contributed to this rise.

• Between 2014 and 2020, antipsychotic use steadily decreased from 27.2% to 20.2%, thanks to significant efforts to address the behavioural and psychological symptoms of dementia by other means.

How this report was developed

Rising Rates: Antipsychotic Use in Canada’s LTC Homes was released by the Long-Term Care Subgroup of the Appropriate Use Coalition, a group of 11 organizations dedicated to improving medication use in Canada. Coalition members include:

• Canadian Institute for Health Information

• Canadian Pharmacists Association

• Canadian Medication Appropriateness and Deprescribing Network

• Centre for Effective Practice

• Choosing Wisely Canada

• The College of Family Physicians of Canada

• deprescribing.org

• Healthcare Excellence Canada

• ISMP Canada

• Neighbourhood Pharmacy Association of Canada

• RxFiles

The report is based on the latest data from CIHI’s Potentially Inappropriate Use of Antipsychotics in Long-Term Care indicator. Nine provinces and territories are included in the analysis: Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and Yukon. Data from Quebec, Northwest Territories, Nunavut and Prince Edward Island was not factored into the analysis or presented in this report.