Canadians in long-term care prescribed antipsychotics without psychosis diagnosis, says report; check key findings

Nearly a quarter of seniors living in Canadian long-term care homes are being treated with powerful antipsychotic medications despite not having a diagnosis of psychosis, according to new national data. The findings are prompting renewed scrutiny of prescribing practices in facilities that care for some of the country’s most medically vulnerable residents.

The analysis, released by the Canadian Institute for Health Information (CIHI), examines safety and quality indicators in long-term care homes for 2024-25. It highlights persistent reliance on antipsychotic drugs to manage behavioural symptoms, particularly among residents with dementia, even when those medications are not clinically indicated for psychotic disorders.

Health professionals typically prescribe these medications to treat conditions involving delusions or hallucinations. However, in long-term care settings, they are sometimes used to manage aggression or agitation, particularly among residents living with dementia.


The Appropriate Use Coalition cited by The Globe and Mail noted that Canada’s rate of potentially inappropriate antipsychotic use is higher than in several comparable countries. The national rate stands at 24 per cent, compared with 10 per cent in the United States, 18 per cent in Australia and 15 per cent in Sweden, according to figures cited in the report.

Pandemic reversal and ongoing risks

Before the COVID-19 pandemic, rates of potentially inappropriate antipsychotic prescribing had been steadily declining. However, CIHI found that usage rose again during the early pandemic years and has remained elevated.

Andrea Foebel, CIHI’s manager of indicator research and development, stressed that clinicians must carefully weigh risks and benefits. She noted that side effects such as drowsiness can reduce quality of life and limit interactions with family and caregivers. Falls are also a major concern, particularly in older adults.

The report did not include data from Manitoba, Quebec, Prince Edward Island or the territories due to insufficient available information.

National target to reduce prescriptions

In 2023, a coalition of national and provincial organizations, the Appropriate Use Coalition, which includes CIHI, was formed to promote safer medication practices.

In 2024, an independent expert panel set a national target: no more than 15 per cent of long-term care residents should receive antipsychotic drugs without a psychosis diagnosis.

CIHI estimates that meeting that target in 2024-25 would have meant roughly 21,000 fewer Canadians receiving potentially inappropriate medications compared with the previous year.

The report also examined other safety indicators. It found that 17 per cent of long-term care residents experienced a fall within a 30-day period before assessment. Residents with dementia or a prior hip fracture are considered at greater risk.

Staffing pressures were also highlighted. In 2023-24, about 8 per cent of total hours worked by direct care staff were overtime. Based on available data from roughly one quarter of Canadian long-term care homes, this amounted to more than three million overtime hours, equivalent to over 1,500 full-time positions.

With Statistics Canada projecting that more than one in five Canadians will be 65 or older by 2030, advocates warn that demand for long-term care will continue to grow, intensifying the need for safer prescribing practices and stronger staffing supports across the sector.