Antipsychotic Use in PALTC May Benefit From Multi-component Approach

February 14, 2023

February 14, 2023

Contact: Ellen Mullally

With the global prevalence of dementia expected to triple by 2050, the urgency to understand the pattern of antipsychotic use in older adults is growing. Adding to this concern, a new study in the February issue of JAMDA showed that 90% of antipsychotic dispensation in Nova Scotia is to long-term care residents.

In Patterns of Antipsychotic Dispensation to Long-Term Care Residents, the authors analyzed data about individuals who are 66 years of age and older and have resided in any of the 92 long-term care homes in the Canadian province. They found that from fiscal years 2009 through 2016, 19,164 Nova Scotia Seniors’ Pharmacare Program (NSSPP) beneficiaries were dispensed antipsychotics and 17,205 of these were long-term care residents. About 40% of Nova Scotia long-term care residents were dispensed an antipsychotic at least once in each year from 2009 to 2016.

Over 1,000 NSSPP beneficiaries were dispensed an antipsychotic up to 100 days before a fall-related hospitalization. Of this group, 50.5% resided in long-term care at the time they got the antipsychotic. The vast majority (90.8%) survived the fall-related hospitalization. Many continued to receive an antipsychotic after hospital discharge. The most commonly dispensed drugs included quetiapine, risperidone, and olanzapine. The authors found that females were more likely to be dispensed an antipsychotic after a fall-related hospitalization, as were those individuals between the ages of 66 and 84.

Overall, the study authors determined that the proportion of men receiving antipsychotics was higher than women; however, the greater number of women residing in long-term care made the number of antipsychotics dispensed to them larger overall.

Not only does the high risk of falls and fall-related hospitalization call for a serious look at antipsychotic use in long-term care, but the costs to the care system are substantial. The authors said that a fall with fracture related to antipsychotic use costs approximately $12,498.64 per event.

The authors noted the potential benefits of a multi-component approach to antipsychotic stewardship. As an example of this, they pointed to a Canadian Foundation for Healthcare Improvement multicenter intervention that included workshops, webinars, and online learning resources. This program also emphasized stakeholder engagement, person-centered approaches to care, staff mentoring, and team engagement. This effort, they said, reduced antipsychotic use in long-term care residents “without indication and found no worsening of behaviors.” There also was a 30% reduction in the odds of staying on antipsychotics in intervention sites compared to control sites.

The study was conducted by researchers at the Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia; College of Pharmacy, Dalhousie University, Halifax, Nova Scotia; School of Kinesiology and Health Science, York University, Toronto, Canada: and Health Data Nova Scotia, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editors for an interview, please email





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.