Expert Panel on Appropriate Use of Antipsychotic Drugs in Long-Term Care

Andrea Moser is a family physician with a focus practice in the care of older individuals. Andrea has worked in long-term care (LTC) homes in Ontario for more than 30 years and is the Corporate Medical Director at the City of Toronto Seniors Services and LTC Division.

Andrea is an advocate of physician engagement and quality improvement in LTC at a local, regional, provincial, and national level. As an associate professor at the University of Toronto (Family and Community Medicine department), Andrea is committed to continuing professional development and lifelong learning.

Andrea is a codeveloper of the Ontario LTC Clinician’s medical director curriculum, which is now legislated for all medical directors in Ontario LTC homes. Related to the appropriate use of antipsychotic drugs, Andrea has contributed to the Choosing Wisely Canada LTC statements, the Centre for Effective Practice appropriate use of antipsychotic drugs toolkit, Institute for Safe Medication Practice Canada’s medication safety in LTC, and numerous continuous professional development workshops on the assessment and management of behavioural and psychological symptoms of dementia. 

Ahmed Vanker is the senior manager of physician engagement and management at Extendicare, where he supports the Chief Medical Officer, Dr. Matthew Morgan. In this capacity, Ahmed leads the antipsychotic drug deprescribing initiative, contributing significantly to the organization’s quality improvement programs and infection prevention, and control strategies. As an international medical graduate, Ahmed holds certifications in infection prevention and control and palliative care best practices.

Before stepping into his current leadership role, Ahmed served as a long-term care (LTC) physician’s assistant, delivering hands-on care to residents, including in outbreak units during the early stages of the COVID-19 pandemic. His front-line experience in Ontario’s LTC sector provided him with invaluable insights into the clinical needs of residents, the challenges of polypharmacy in these settings, and the collaborative efforts required by care teams to consistently deliver high-quality care. Ahmed’s dual focus on clinical excellence and strategic management positions him as a key contributor to Extendicare’s mission of enhancing the quality of care across all its facilities. His work continues to be driven by a deep commitment to improving patient outcomes and supporting the well-being of both residents and health care providers. 

Ashley King is the chief executive officer of Loch Lomond Villa and has been contributing to aging care since 2010. Ashley holds a Bachelor of Arts with a dual concentration in gerontology and psychology from St. Thomas University. She also received her Dementia Care Mapping Certification through the University of Bradford in the UK. Most recently, Ashley completed a global executive master’s degree in business administration from Rotman School of Management at the University of Toronto.

Ashley has worked with long-term care (LTC) homes across New Brunswick informing dementia care practice and the use of non-pharmacological interventions to provide quality of life for those living with dementia. Ashley’s background in therapeutic recreation and person-centred dementia care position her well for this role. She also brings her personal experience providing care to her grandmother at home and a deep understanding of aging and LTC systems across the world that demonstrate her ability to contribute positively to the work of Canada’s Drug Agency and Choosing Wisely Canada. 

Aswathy is a registered nurse, holds a bachelor’s degree in nursing, and master’s degree in psychology and sociology. Currently, Aswathy is a member of Canadian Nurses Association (CNA) and serves as the antiracism advisory council board member for CNA. Aswathy is a compassionate, dedicated, health care professional with 10 years of experience in the health sector.

Aswathy has a Gerontology Nursing Certification from the CNA and certifications in Understanding Dementia and Preventing Dementia from the Wicking Dementia Research and Education Centre at the University of Tasmania.

As a nurse with experience in long-term care (LTC) homes, Aswathy has sometimes seen antipsychotic drugs used to treat behavioural and psychological symptoms of dementia, such as aggression, anxiety, and agitation. To provide person-centered care and enhance the quality of care and services, most of the LTC homes have developed and implemented measures for deprescribing antipsychotic drugs. Aswathy has noted a decline in the use of antipsychotic drugs with nonpharmacological interventions. 

Carole Goodine is a pharmacist and clinical pharmacy manager at the Dr. Everett Chalmers Regional Hospital. She has professional experience managing antipsychotic drug use in both acute care and long-term care settings.

Carole holds a Bachelor of Science in Pharmacy, a Doctor of Pharmacy, an Accredited Canadian Pharmacy Residency Certificate, and a postdoctoral research fellowship.

As a practising pharmacist, Carole has worked with older adults and their families in community, nursing home, and hospital settings in 3 Canadian provinces. She was a nursing home pharmacist consultant in Ottawa and Halifax. She has led several deprescribing research studies in New Brunswick, including a small project to reduce sedative hypnotic use at York Care Centre and a larger project to develop and evaluate technology to facilitate deprescribing in nursing homes.

For the past 5 years, Carole has participated in antipsychotic drug medication review rounds with a geriatrician and nurse manager on the transitional care unit at the Dr. Everett Chalmers Hospital. She enjoys working in a team environment and has diversity, equity and inclusion training. She is committed to improving medication management for older adults. 

Cynthia Sinclair is a graduate of the University of Manitoba. She is a retired registered nurse with a 35-year career that includes acute care, community care, and long-term care (LTC) experience. She has worked in a variety of roles: manager of centralized services home care, Winnipeg Regional Health Authority (WRHA); LTC manager of initiatives WRHA and, “Standards & Development” at the Interlake-Eastern Health Region in Manitoba; LTC program director WRHA, Director of Care for a large Winnipeg LTC home; and chief executive officer of a LTC facility in England.

In 2012, she graduated from Healthcare Excellence Canada’s (HEC) EXTRA Fellowship Program; her Intervention Project was chosen by HEC to spread across the country as an example of an appropriate use of antipsychotic drugs approach and she continues as an HEC coach.

In her various roles, Cynthia has mentored and coached others to build effective and cohesive teams and has worked to include families into program design. Using her expertise and experience, she has worked tirelessly with many LTC homes and organizations across the country to create and sustain person-centered care environments that improve the lives of residents. 

With more than 20 years of experience as a registered nurse and her master’s degree in nursing, Julie Weir has served several roles across the New Brunswick health care sector. These include both the acute and LTC sectors, from front-line intensive care nursing to providing provincial leadership.

Julie has served as the provincial lead for the scale and spread of the appropriate use of antipsychotic drugs initiative as well as the implementation of the interRAI LTCF assessment across all nursing homes in New Brunswick. Julie recently served as chief executive office of the New Brunswick Association of Nursing Homes. Currently, Julie is the regional nurse manager for the Infection Prevention and Control program with Horizon Health.

Julie is the current president-elect to the board of directors with the Infection Prevention and Control Canada organization and continues to provide quality improvement and evaluation coaching supports through Healthcare Excellence Canada (HEC) for a number of their initiatives. Julie serves as one of the clinical co-leads to the long-term care group with Choosing Wisely Canada and is a PhD student with the University of New Brunswick. 

Geneviève Lemay is an associate professor of medicine at the University of Ottawa within the Division of Geriatrics. She holds responsibilities in the development of specialized older adults services for francophones with the Regional Geriatrics Program of Eastern Ontario. She has a large clinical practice at Hôpital Montfort focusing on both inpatient and outpatient frail older adults, and those living with dementia.

She has a MD designation from the University of Ottawa with a Royal College Specialization in internal medicine and subspecialization in medicine for older adults. She also holds a bachelor’s degree in nursing and a master’s degree in interdisciplinary health science from the University of Ottawa. Her research interests include delirium and dementia care during acute hospitalizations, polypharmacy, and deprescribing (with her role in the creation of antipsychotic drug deprescribing guidelines). She has been involved in the faculty in undergraduate medical education for more than 8 years as an assistant dean of admissions. 

With more than 15 years in hospitality management and more than 25 years in the legal industry as a firm administrator, Lisa Dawson shifted her focus and skills into the long-term care (LTC) space; specifically to the advocacy for quality of life and quality of care of residents. Quality of care and residents’ quality of life are highly dependent on feedback from residents and their families.

Lisa was her father's caregiver in her home for 10 years. During that time, she witnessed many gaps in the community health care system. This led to her father’s assessment and entry into LTC.

Her acquaintance with antipsychotic drugs and pain medication in LTC became well established. She found her voice in family council and realized how many other family members had stories about the use, misuse, and overuse of drugs in the LTC setting.

Her current roles include the following: 

• family caregiver (for her father in LTC) 
• co-chair of a family council (Louis Brier Home and Hospital) 
• chair of the Vancouver Coastal Association of Family Councils 
• vice-president and secretary of the Independent Long-Term Care Councils Association BC (ILTCCABC) 
• family councils advocate: Be the change you want to see! 
• raise your voice: LTC. 

Marie-Andrée Bruneau graduated in psychiatry from the University of Montreal in 2001, with a master’s degree in biomedical sciences. Certified as geriatric psychiatrist, she is a professor in the Department of Psychiatry at the University of Montreal where she was the executive director of the geriatric [older adults] psychiatry division from 2011 to 2020.

She is also a researcher at the Institut Universitaire de Gériatrie de Montréal, where she led the behavioural and psychological symptoms in dementia (BPSD) program. She collaborated closely with the Alzheimer Plan of the Quebec Ministry of Health, where she oversaw the development of BPSD teams in the province and guided the clinical trajectory for BPSD management. She has been involved in the expert panel of the latest BPSD guidelines from the Canadian Coalition for Seniors Mental Health. She was also a faculty member of the OPUS-AP (Optimizing Practices, Use, Care, and Services-Antipsychotics) program in Quebec. 

Shanna Trenaman is a residency-trained hospital pharmacist with experience caring for older adults in hospital. Shanna is a PhD-trained researcher with experience in pharmacoepidemiology, pharmacology, and clinical trials. Shanna is an assistant professor at the College of Pharmacy at Dalhousie University and affiliated with older adult medicine research at Nova Scotia Health.

Shanna is interested in improving appropriate medication use in older adults to minimize adverse drug events and improve quality of life. Shanna is also a caregiver to her father-in-law who lives with early onset Alzheimer disease. After his diagnosis, he lived nearly 3 years in the community with family support and then he moved to a long-term care home in Nova Scotia in January of 2024. 

Sid Feldman is an associate professor and the Head of the Division of Care of the Elderly in the Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto. At Baycrest Health Sciences, he serves as the Chief of Family and Community Medicine and the Executive Medical Director of Residential Programs.

Provincially, he is the past-chair of the steering committee for the Provincial Geriatric Leadership Ontario and for more than 15 years, he has served on the Ontario Chief Coroner’s Geriatric Review Committee. Nationally, he heads the Members Interest Group in Care of the Elderly at the College of Family Physicians of Canada (with more than 4,000 family physician members) and is co-chair of Choosing Wisely Canada’s long-term care program.

He is a committed comprehensive family physician, affiliated with the North York Family Health team and with the Department of Family and Community Medicine at North York General Hospital. Dr. Feldman has interest in the primary community care of older adults and care of those living in long-term care. Key topics that include his authorship on are clinical practice guidelines on osteoporosis and fracture prevention in 2010 (community) and 2015 (long-term care) as well as new guidelines published in October 2023. He is also an author on the 2024 Canadian Coalition for Seniors’ Mental Health clinical practice guidelines for assessing and managing behavioural and psychological symptoms of dementia. 

Shirin Vellani is a nurse practitioner with extensive experience in specialized older adults services, including acute care, community, and long-term care (LTC) where she worked with diverse older adults. She completed her PhD in nursing science with a collaborative program in aging, palliative, and supportive care at the University of Toronto.

Currently, Shirin works as a nurse practitioner-researcher in the Virtual Behavioural Medicine (VBM) program at the Toronto Rehabilitation Institute of the University Health Network. The VBM program is a novel interdisciplinary model of care designed to address neuropsychiatric symptoms of dementia in older adults living in LTC homes through pharmacological and non-pharmacological strategies. She is involved in various research and educational activities to optimize the care of older adults, particularly those living with dementia, through increasing the capacity of the health care workforce and implementing the role of nurse practitioners. 

Dr. Vivian Ewa is a care of older individuals physician and clinical associate professor in the Department of Family Medicine at the University of Calgary. She is also the medical director for the Alberta Health Services, Calgary Zone Seniors, Palliative and Continuing Care portfolio.

Her clinical practice involves consultation at the Bridgeland Seniors’ Health Clinic, Geriatric Consult team and Seniors Health Outreach Program (SHOP) to long-term care (LTC) and supportive living facilities in Calgary. She has served on various committees at the local, provincial, and national levels, such as the behavioural and psychological symptoms of dementia (BPSD) guidelines development panel, chair of the Alzheimer Society of Canada communicating dementia diagnosis topic guidelines development panel and member of the scientific planning committee for the Canadian Geriatrics Society. She sits on the Appropriate Prescribing and Medication Use Strategy for Older Albertans committee and is a member of the Alberta Provincial Continuing Care Quality committee.

Vivian has participated in several research and QI projects, including the development of a care referral pathway to optimize the transfer of LTC residents to emergency department during times of medical urgency. She collaborated with researchers in Indigenous research to develop a care pathway for Indigenous People living with dementia. This collaborative work acknowledges the need to incorporate Indigenous ways of knowing and cultural-informed approaches to caring for Indigenous People living with dementia. She also sits on the advisory committee for physician education on caregivers-in Alberta. In 2014, she collaborated on a QI project to reduce physical restraint use in hospital. Findings were published in the Journal of the American Geriatrics Society in 2016. She also codeveloped a CME module on BPSD that is available on the University of Calgary CME page for physicians in 2018.