Potentially Inappropriate Use of Anti-psychotics in Long Term Care Facilities

Ever since the inappropriate use of anti-psychotics has become a quality indicator for public access in Canada, many long term care facilities are paying a closer look at their numbers. In particularly, the average use of inappropriate use of anti-psychotics in Ontario was around 30% about 2 years ago. I am happy to see that it has dropped significantly. Currently it is sitting at 22.9%.

This information is provided by CIHI – Canadian Institute of Health Information.  They define inappropriate use of anti-psychotic as individuals on an anti-psychotics without a diagnosis of schizophrenia, or Huntington’s chlorea, or those experiencing hallucinations or delusions. It also excludes individuals who have end-stage disease or receiving hospice care.  For more information, please click here.

We can agree or disagree with this definition. For instance, many residents with bipolar affective disorder may be appropriately treated with antipsychotics or residents with refractory depression may require the use of antipsychotics that can be construed as appropriate based on the treatment guidelines.

But these individuals are considered inappropriate use based on this definition. 

While there are limitations with this definition, the overall number and trends do provide some insights into the facility’s culture of using anti-psychotics. And I am glad to see the numbers  are going down nicely.


In particular, I am very impressed with how many facilities are encouraging the use of therapeutic recreation experts to help manage behaviours in the facilities. We are looking at how to incorporate non-drug measures such as music therapy, art therapy, gardening therapy, or simply setting up a cafe for residents to enjoy a cup of coffee or tea. I think when we start to change the culture to respect residents, to treat them like human beings instead of institutionalized residents and to make time to listen to them, they respond positively. They appreciate in their own way despite of the severity of the dementia.

There is still a role in using anti-psychotics for managing behaviour in dementia. But I am glad overall we are moving in the right direction and I hope we continue to do so in the coming years.


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My name is Cynthia Leung and I am a practicing pharmacist in Kingston Ontario, Canada. This blog is for me to share my ideas, opinions and perspectives on how medications are used in our health care system. Note that these posts are my own opinions and do not represent the opinions of my current or former employers and / or organizations that I may belong to. Any possible case scenarios described in my posts would be modified to maintain patient confidentiality. This blog is not a platform for professional advise for patients or health care providers and the content is not meant to support any clinical decisions or replace professional opinions. Also the images are either taken or created by the author, or adapted with permissions. I hope you will enjoy reading my posts!

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