Atlantic Long Term Care Network

Reducing polypharmacy in long-term care facilities in our region


The issue

Polypharmacy - the use of more medications than is clinically necessary - is a significant problem among the elderly. (1)

Atlantic Canada has the highest proportion of seniors in Canada – with approximately 21,850 residents in 479 long-term care (LTC) facilities. (2) These individuals are typically frail, have multiple chronic illnesses, and an average life span of two to three years. (3, 4)

While the above facts highlight the importance of looking closely at prescribing practices in this population, most current clinical guidelines are for the non-frail patient who does not have multiple chronic conditions. (5, 6)

The approach

Dalhousie CPD is helping to coordinate a strategy in Atlantic Canada to ensure appropriate prescribing practices for LTC residents with the aim of providing safer, more efficient care, and reducing health care costs.

The Atlantic Long-Term Care Network (ALTCN) was formed in September 2012, and includes stakeholders focused on reducing polypharmacy and promoting appropriate prescribing for the frail elderly in LTC.

Who are we?

We are policy makers, geriatric and primary care physicians, LTC administrators, researchers, nurse practitioners, pharmacists, educators, and patient advocates. We have met monthly since our inception and have developed a strategy to leverage existing initiatives and tools to address polypharmacy. Our work will inform broader implementation and evaluation in the Atlantic Provinces (NS, NB, PE, NL).

For more information, please contact the Dalhousie CPD Evaluation Specialist, Tanya MacLeod,





  1. Introduction [Internet]. Amherst, NS:; 2013 [cited 2015 Jun 30]. Available from:
  2. Statistics Canada. Residential care facilitites 2009/2010 (Catalogue no. 83-237-X) [Internet]. Ottawa, ON: Statistics Canada; 2011 [cited 2015 Jun 30]. Available from:
  3. Theou O, Rockwood K. Should frailty status always be considered with treating the elderly patient? Aging Health. 2012; 8(3): 261-271.
  4. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173(5):489-495.
  5. Beglinger C. Ethics related to drug therapy in the elderly. Dig Dis. 2008; 26(1):28-31.
  6. Mutasingwa DR, Ge H, Upshur RE. How applicable are clinical practice guidelines to elderly patients with comorbidities? Can Fam Physician. 2011; 57(7):e253-262.
  7. Mallery LH, Allen M, Fleming I, et al. Promoting higher blood pressure targets for frail older adults: a consensus guideline from Canada. Cleve Clin J Med. 2014; 81(7):427-437.
  8. Mallery LH, Ransom T, Steeves B, Cook B, Dunbar P, Moorhouse P. Evidence-informed guidelines for treating frail older adults with type 2 diabetes: from the Diabetes Care Program of Nova Scotia (DCPNS) and the Palliative and Therapeutic Harmonization (PATH) program. J Am Med Dir Assoc. 2013; 14:801-808.
  9. Mallery L, Moorhouse P, McLean-Veysey P, Allen M, Fleming I. Acknowledging frailty: a consensus guideline for the use of statins and other lipid-lowering medications in older adults who are severely frailty. Manuscript under review.