### The Increasing Employment of Antipsychotics in Long-Term Care: Acknowledging the Issue and Planning for Improvement

The use of antipsychotic drugs in long-term care (LTC) environments for elderly individuals dealing with dementia-related symptoms such as agitation or aggression is a complicated and urgent concern. While these drugs can be essential for managing severe symptoms, their prolonged and widespread application has prompted significant worries among healthcare professionals and policymakers. A recent study has highlighted a concerning trend: nearly **one in four LTC residents in Canada is prescribed antipsychotic medication possibly unnecessarily**, a percentage that has been on the rise since the COVID-19 pandemic.

This article explores the contributing factors to this disturbing trend, the dangers linked to inappropriate antipsychotic prescriptions, and approaches that emphasize person-centered care for some of Canada’s most at-risk populations.

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### The Alarming Surge in Antipsychotic Prescriptions

Data from the **Canadian Institute for Health Information (CIHI)** indicates that before the pandemic, the national rate of potentially inappropriate antipsychotic prescriptions for LTC residents without a psychosis diagnosis stood at **20%**. Nevertheless, this figure has risen to **24%**, undoing prior progress in reducing such prescriptions. Canada now ranks among the highest in antipsychotic dispensing in LTC compared to other nations like the **United States (10%)** and **Australia (18%)**.

The pandemic seems to have intensified the situation. Statistics reveal that each province and territory saw at least a **2% increase** in antipsychotic prescription rates. Factors like isolation protocols, workforce shortages, and diminished time for personalized care likely contributed to this increase.

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### The Dangers of Excessive Antipsychotic Use in Seniors

Antipsychotic medications pose significant risks, especially for older adults, particularly those with dementia. These risks include:

– **Stroke:** Antipsychotics elevate the chance of cerebrovascular incidents.
– **Falls and Fractures:** The sedative effects and dizziness associated with these medications increase the risk of falls, potentially resulting in fractures and hospital stays.
– **Increased Mortality:** Research has shown a higher mortality rate linked to long-term antipsychotic use among dementia patients.
– **Cognitive Decline:** Rather than enhancing life quality, antipsychotics can worsen confusion and damage cognitive abilities.

Considering these dangers, prescribing antipsychotics without investigating alternative methods not only constitutes a clinical misstep but also represents an ethical problem.

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### Non-Pharmacological Strategies: Alternatives to Antipsychotic Medications

A key takeaway from pre-pandemic initiatives aimed at reducing antipsychotic prescriptions in LTC settings is the significance of **person-centered care**. This method focuses on grasping the distinct histories, behaviors, and requirements of each resident. Non-pharmacological methods for managing challenging behaviors encompass:

– **Pain Management:** Unaddressed pain is a frequent trigger for agitation in older individuals. Identifying and alleviating pain can often mitigate distressing behaviors.
– **Therapeutic Engagement:** Techniques such as music therapy, reminiscence therapy, and sensory stimulation have proven effective in soothing residents with dementia and improving their mood.
– **Routine Modifications:** Maintaining familiar routines and environments can help lessen confusion and anxiety.
– **Staff Education:** Training caregivers to defuse agitation and respond compassionately to residents’ needs diminishes dependence on medications.

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### How the Pandemic Derailed Progress

Before the pandemic, Canada had made notable advances in addressing this challenge through comprehensive **dementia care education and enhancement programs**. LTC facilities received support with tools and resources to better identify the underlying causes of distressing behaviors and transition residents away from potentially inappropriate antipsychotic medications.

However, the COVID-19 crisis interrupted these initiatives. LTC homes were compelled to emphasize infection control, including isolating symptomatic residents to curb virus spread. This shift in focus resulted in unintended outcomes:

1. **Diminished Individualized Care:** Isolation protocols frequently neglected the emotional and psychological needs of dementia residents.
2. **Increased Staff Turnover:** Many caregivers exited their jobs during the pandemic, leaving facilities short-staffed and overwhelmed.
3. **Lack of Training and Continuity:** New and temporary staff often lacked knowledge of residents’ preferences and histories, as well as training in non-pharmacological care techniques.
4. **Medication as a Reactive Solution:** In some environments, medications emerged as the primary response for managing behaviors, even when they were not clinically justified.

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### The Way Forward: A Call to Action

The escalating use of antipsychotics in LTC serves as a crucial alert for healthcare providers, policymakers, and the public. Tackling this issue calls for a **coordinated, multi-faceted strategy**:

#### 1. **Establishing National Standards and Objectives**
Creating national standards