Gender Matters, Age Counts: Patterns of Antipsychotic Prescribing in Canadian Long-Term Care Homes.

Antipsychotic use carries many risks, including increased mortality. Although interventions exist to reduce inappropriate prescribing, strategies tailored to the underlying drivers of use remain unexplored. This study investigates how resident and facility factors influence antipsychotic use in Canadian Long-Term Care (LTC) homes, focusing on age and gender disparities. We conducted a retrospective longitudinal analysis of residents aged 65 and older without psychosis in LTC homes across six provinces and territories, using data from the first quarters of 2010-2022. Antipsychotic initiation was associated with male gender, cognitive and behavioural impairment, specific psychiatric diagnoses, non-English/French language, and residence in larger LTC facilities. The highest odds were observed among residents aged 65-74 and male residents with aggressive behaviour. These findings highlight the need for gender-responsive clinical strategies and facility-level interventions to promote equitable prescribing. Reduced use among oldest residents is encouraging, but elevated rates in younger seniors indicate a subgroup requiring targeted approaches.