From reaction to prevention: the challenge of antipsychotic reduction

A study shows 49 percent of people in long-term care are prescribed anti-psychotic medication, with more than 31 percent of prescriptions remaining the same for more than a year. This is having a cumulative effect both on individuals, communities and staff.

But what can be done to remedy this?

For too long, our approach to distress in dementia care has been reactive. There has been a focus on analysing causes after incidents occur, treating behaviour as a problem to be solved rather than a form of communication to be understood.

While understanding causes has value, we need to shift our focus upstream to prevention rather than reaction and keep people living with dementia mate wareware at the centre of what we do.

The emerging field of Positive Behaviour Support (PBS) offers significant promise in this regard. While widely used and successful in other sector, PBS has been slow to bring its benefits to dementia care.

The language of PBS is not my favourite, but the whole application of it as an approach to dementia care has potential. What we need to do is take the best bits of it and apply it thoughtfully to the unique needs of people living with dementia mate wareware.

PBS brings several specific benefits to dementia care. It provides an integrated framework that links values, theory and practice. The approach establishes a foundation for creating a ‘capable environment’ and offers an organisational focus that situates micro-practices within the broader context of the organisation. PBS advocates for the use of data and evidence-based practices, providing a framework for change management and quality improvement.

Importantly, PBS identifies the role that trauma can play in behavioural presentation and clearly distinguishes the ‘form’ of behaviour from its ‘function’. Rather than focusing solely on behaviour, PBS emphasises quality of life.

It uses data to demonstrate reduction in intensity, frequency, or duration of distress, and encourages active support while defining both slow and fast triggers for distress.

What this means for people living with dementia mate wareware is there is a framework to identify and respond to distress in a way that people feel heard and understood.

Beyond analysis: the limitations of the causes approach

Traditionally, we’ve been trained to analyse distress after it occurs by examining causes. We look for physical health issues such as infections, pain or sensory impairments. We consider mental health factors like depression, anxiety or trauma. We examine cognitive factors. We assess social dynamics around dignity, respect, and meaningful interaction. We scrutinise environmental elements like noise, lighting, and orientation.

Whilst understanding these factors has value, this approach is fundamentally reactive – we’re responding after distress has already happened. It’s a bit like closing the stable door after the horse has bolted, right? To truly transform care, we need to move beyond analysis to prevention.

Prevention looks like understanding what people need to feel psychologically safe.

A whole-system approach to prevention

Reducing antipsychotic use requires addressing every aspect of the care ecosystem proactively. Drawing from PBS principles, we can implement both primary prevention (creating environments that promote wellbeing before problems arise) and secondary prevention (early intervention strategies that respond to initial signs of distress). Rather than waiting for distress to occur, we can build prevention into the entire system.

For example, this could look like understanding both what people need to feel safe and what the early signs of distress are.

This isn’t just fancy talk – it’s about rolling up our sleeves and doing the real mahi (work) of transformation across every aspect of care.

Community and inclusion for people living with dementia mate wareware are essential elements of prevention. This means proactive community integration and the development of valued social roles. Life history should be integrated into daily support, and cultural needs addressed in everyday care.

Reducing antipsychotic medication in dementia care isn’t achieved through medication reviews alone. It requires redesigning systems to work for people, not against them.

By shifting our focus from analysing past incidents to preventing future distress, we can create capable environments, develop well-trained staff and foster a culture of enablement and inclusion.

The goal isn’t just fewer prescriptions it’s better lives for people with dementia mate wareware, built on understanding, dignity, and proactive, person-centred support.

Other considerations include:

• Recruitment and staffing
• Learning and development
• Data and documentation
• Safety and risk management
• Environment and resources
• Organisational culture
• Health and safety

The power of language in transformation

Before we can transform systems, we must transform our language. The words we use shape our perceptions and responses. “Aggressive” strips away humanity; “angry,” “upset,” or “frustrated” acknowledges emotion. “Wanderer” overlooks needs; “person who walks” respects autonomy. “Behaviour” suggests problems; “communication” recognises expression.

Language isn’t just semantics – it’s the foundation of care

We’ll soon be launching consultancy services to support organisations in this transformational mahi. We understand the incredible care already being provided and are passionate about helping aged care services become the best versions of themselves.

Our approach honours the great work organisations are already doing while offering pathways to enhance prevention-focused systems that benefit both residents and staff.

Get in touch to learn how we can support your organisation’s journey toward excellence in dementia care.

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