Apr 2016
Antipsychotics in Dementia Care
Introduction
There are currently ~500,000 older adults with dementia in Canada. Understand the best practices for assessing and managing patients with dementia, with a particular focus on the use of antipsychotics using the Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guides - primary care, long-term care, or resident, family and caregiver editions.
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In the Know: Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia
Our video on the Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia, featuring Dr. Sid Feldman, with information about how to assess and manage dementia, and how primary care providers can use this tool in their practice. Visit: effectivepractice.org/dementia
DIGITAL
iOS and Android App
This app is designed to help providers understand, assess and manage residents in LTC homes with behavioural and psychological symptoms of dementia (responsive behaviours), with a focus on antipsychotic medications. The app integrates best-practice evidence with clinical experience, and emphasizes the following important principles:
- Being resident-centred
- Being mindful of benefits, risks and safety concerns
- Using an interprofessional team approach and validated tools
- Prescribing conservatively
- Reassessing regularly for opportunities to de-prescribe medications that are no longer needed
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iOS: Use of Antipsychotics in BPSD
Android: Use of Antipsychotics in BPSD
Information
About the tool
The Centre for Effective Practice (CEP) developed three tools to help promote a better understanding of best practices for assessing and managing patients with dementia, with a particular focus on the use of antipsychotics. The content is similar in each Tool, with modifications to meet the needs of the following audiences:
- Primary Care Edition — for primary care providers.
- Resident and Caregiver Edition — specifically for families, caregivers and residents of Long-Term Care Homes.
- Long-Term Care (LTC) Edition — for providers, administrators, caregivers, and interested residents and families in long-term care homes as part CEP’s Academic Detailing Service.
Each tool contains information to help providers, caregivers, family members and long-term care home residents:
- Use non-drug therapy as an important part of management, regardless of whether drug therapy is initiated.
- Understand when and how to initiate drug therapy for appropriate symptom clusters. Each edition of the tool includes references to relevant existing tools, strategies and services.
- The LTC edition was used as a resource for an academic detailing service provided by the CEP.
- Discuss and document behavioural and psychological symptoms of dementia.
- Weigh the benefits and harms of using antipsychotics.
The Long-Term Care, and Resident and Caregiver Editions of the tool were developed as part of Centre for Effective Practice’s academic detailing service for long-term care homes. The Primary Care Edition of the tool is one of several resources developed as part of the 2014 to 2017 Knowledge Translation in Primary Care Initiative (KTinPC). This multi-year initiative was a collaboration between the Centre for Effective Practice (CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supported primary care providers with the development of a series of clinical tools and health information resources.
The Primary Care Edition of the Tool was developed in parallel with the Long-Term Care and Resident and Caregiver Editions using CEP’s integrated knowledge translation development methods. CEP ensures that healthcare providers are engaged throughout the tool development process, using a user-centered design methodology to test the usability of tools from a provider perspective. CEP’s Academic Detailing Service Team, with clinical leadership from Dr. Sid Feldman developed, the Primary Care Edition.
Clinical leads
Andrea Moser
MD, PhD
Dr. Andrea Moser is a family physician with a clinical practice is in long term care and home visits for housebound frail seniors at Baycrest Health Services. She is an Assistant Professor in the Department of Family and Community Medicine, University of Toronto; Associate Medical Director, Apotex Nursing Home at Baycrest; and is a Certified Medical Director through the American Medical Directors Association. At Baycrest she is also co-chair of the Apotex Quality Subcommittee and a member of the Quality Steering Committee. She also has extensive experience in rural practice. Dr. Moser has a particular interest in dementia care and is involved with the Behavioural Supports Ontario (BSO) program through her clinical work at Baycrest on the Transitional Behavioural Support Unit and the LTC Behavioural Support Outreach Team and is the BSO primary care lead for Central LHIN. Dr. Moser is the chair of the OMA Section of Care of the Elderly and LTC, and a member of the Board of Directors of the Long Term Care Medical Directors Association of Canada.
Dr. Moser provided clinical leadership for the development of the long-term care resources and was offered compensation for her role.
Sid Feldman
MD, CCFP, FCFP
Dr. Sid Feldman is a community family physician affiliated with the North York Family Health Team. He also works as attending physician in the Toronto Central LHIN Behaviour Support Unit at Baycrest for residents with behavioural symptoms of dementia. His academic and administrative roles at Baycrest include Medical Director, Home for the Aged, Executive Medical Director Residential and Aging at Home Program and Chief, Family and Community Medicine. He is an Associate Professor and Coordinator, Care of the Elderly Program in the Department of Family and Community Medicine, University of Toronto and serves as the Ontario representative on the CFPC Health Care of the Elderly Program Committee.
Dr. Feldman provided clinical leadership for the development of the long-terms care resources and was offered compensation for his role.
Kristin Ferguson
PHARMD
Kristin Ferguson is an experienced community pharmacist. She has managed a community pharmacy for more than seven years while becoming involved in the non-profit healthcare sector. Kristin completed her pharmacy degree at the University of Toronto and also received her Bachelor of Health Science from the University of Western Ontario with an interest in health promotion in a rural setting. As a volunteer, Kristin has worked with the Port Hope Community Health Centre for many years and now sits on the board of directors. This reflects her commitment to giving back to her community. Kristin enjoys the outdoors and also spends time canning and preserving with produce from her farm.
Expert Reviewers
Usability participants received a token of appreciation (e.g., gift certificate).