Photo credit: Baycrest
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, person-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. Antispychotics 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.
Baycrest’s Apotex Centre, Jewish Home for the Aged tries 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 individuals 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.
Baycrest also empowers point of care staff to think critically and creatively about how to deliver person-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.
“Staff were concerned about resistance to care. We were able to provide staff with training so they would be comfortable in their skills and abilities,” says Sian Harrylal, Quality and Implementation Specialist at Baycrest. “GPA training allows the staff to feel comfortable now bringing residents forward [to consider gradual antipsychotic reduction]. We’re very lucky to have all of these resources to support staff, residents and families.”
Baycrest has shown that reducing antipsychotic use leads to better outcomes and safer care.
This approach has made a meaningful difference in the lives of residents and staff alike. By focusing on personalized care, empowering staff and fostering a culture of curiosity and compassion, Baycrest reduced the use of unnecessary antipsychotic medications from 30% to 20% over two 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.