HN Summary
• Baycrest’s interdisciplinary, resident-centred approach addresses the behavioural symptoms of dementia by identifying and responding to underlying physical, emotional, and environmental needs, rather than relying primarily on antipsychotic medications.
• Staff are trained in non-pharmacological strategies, including Gentle Persuasive Approaches, therapeutic activities, and personalized engagement programs, to safely reduce reliance on antipsychotics and enhance resident quality of life.
• Over the past three years, Baycrest’s efforts have lowered unnecessary antipsychotic use from 30% to under 20%, demonstrating that holistic, individualized care improves outcomes, safety, and dignity for older adults living with dementia.
Managing the behavioural symptoms of dementia remains one of the most complex challenges in geriatric care. Baycrest’s expertise in care for older adults has shaped a more nuanced and evidence-based understanding of how complex, overlapping conditions manifest in aging populations, many of which can be addressed without medication.
Pharmacological interventions are frequently relied upon to address agitation, aggression or psychosis, but their use in aging adults carries well-documented risks. Their overuse also underscores a missed opportunity to address the source of behavioural symptoms of dementia which are often rooted in unmet physical, emotional or environmental needs.
Baycrest’s interdisciplinary team of experts prioritizes holistic, resident-centred care that seeks to assess and address potential underlying causes for changes in behaviour.
After a period of gradual reduction in use, antipsychotic use has been on the rise again in long-term care homes across Canada, since the onset of the COVID-19 pandemic in 2020. Antipsychotics are often prescribed to manage misunderstood responsive behaviours: actions, words or gestures presented by a person with dementia to respond to something negative, frustrating or confusing in their social and physical environment.
While sometimes necessary, for example in people experiencing psychosis or severe agitation, overreliance on this kind of medication poses serious risks such as sedation, increased falls and even premature death.
At Baycrest’s Apotex Centre, Jewish Home for the Aged, we strive to keep the rate of antipsychotic use as low as possible. The first step – a critical one – is to really understand who residents are as people from the person themselves and their families. The better residents are understood, so are their needs and how to address them.
“One of the amazing things we’ve seen through the process of reducing the use of antipsychotic medications in long term care is that it’s not the fancy stuff that makes the difference. The holistic, tailored approach – understanding the individual and incorporating activities that are meaningful and enjoyable – is where the magic is,” reflects Dr. Sid Feldman, Executive Medical Director of Long Term Care and Residential Program and Chief, Department of Family and Community Medicine at Baycrest.
Getting outside, being physically active and engaging in fulfilling activities like listening to music can do wonders as far as meeting the needs of residents and bringing joy to their lives. At Baycrest, this is supported through a range of therapeutic and recreational programs including music therapy, scent therapy, creative arts, pet visits and more, all designed to meet each resident’s individual needs and abilities to engage and foster a sense of purpose.
Baycrest also empowers point of care staff to think critically and creatively about how to deliver resident-centred, tailored care. Nurses, personal support workers (PSWs) and therapeutic recreationists understandably expressed concerns about responsive behaviours when medications are reduced. That’s why they’re provided with training in Gentle Persuasive Approaches (GPA) which builds confidence and practical skills for responding in non-pharmacological ways.
When a committed team works as one, meaningful change becomes possible. That’s why Baycrest’s Apotex Centre, Jewish Home for the Aged invests in capacity building initiatives for all members of the care team. Alongside GPA, we offer focused in services on person centred care, mental health in older adults and supporting residents with responsive behaviours. These efforts ensure staff are equipped with the knowledge, skills and confidence to deliver individualized, compassionate care rooted in understanding each resident rather than simply managing symptoms.
Reducing unnecessary antipsychotic use is a gradual, collaborative process that involves the full interdisciplinary care team, alongside residents and their families. Decisions about medication are made thoughtfully and on a case-by-case basis, informed by clinical expertise, ongoing dialogue and the lived experiences of each resident. This measured approach helps ensure that changes in care are positive, safe and meaningful for each resident.
Baycrest has shown that reducing antipsychotic use leads to better outcomes and safer care. Our efforts have been recognized with an Impact Award as part of Healthcare Excellence Canada’s Sparking Change in the Appropriate Use of Antipsychotic Awards Program.
Critically, the success of this work relies on continuous evaluation. Baycrest’s Responsive Behaviours Program applies quality improvement methods to monitor key indicators such as residents admitted on antipsychotics, dose reductions, medications discontinued and as-needed (PRN) medications removed, ensuring interventions are effective and tailor to each resident’s needs.
This approach has made a meaningful difference in the lives of residents and staff alike. By focusing on personalized care, empowering staff and applying quality improvement methods to guide and evaluate change, Baycrest reduced the use of unnecessary antipsychotic medications from 30 per cent to under 20 per cent in the last three years. It’s a reminder that when health care professionals listen, support and innovate together, they can create safer, more dignified care for those who need it most.
Tejas Patel, Manager, Baycrest’s Apotex Centre, Jewish Home for the Aged oversees programs that support person-centred care for older adults living with dementia. Tejas leads the Responsive Behaviours Program, applying methods to enhance resident well-being and safety.