Hong Kong—The rates of antipsychotic drug prescribing among people with dementia increased during the COVID-19 pandemic, according to an international study that included data from the United States.
Since antipsychotic drugs offer only modest effectiveness and increase the rates of adverse effects, they are recommended only as a last resort for dementia patients with behavioral and psychological symptoms.
Yet, a cohort study including data for 857,238 patients with dementia diagnosis from eight databases revealed that antipsychotic drug prescribing rates significantly increased in the first months of the pandemic compared with corresponding months in 2019 in France, Italy, South Korea, the United Kingdom, and the U.S. Those rates remained high in 2021, with the most substantial increases found in South Korea and UK databases, according to the article in the Journal of the American Medical Association Psychiatry.
“The findings suggest that the COVID-19 pandemic disrupted the care of people with dementia and that intervention strategies need to be developed to ensure the quality of care,” the authors advised.
The study used information from electronic health records and claims data from eight databases for patients aged 65 years and older (58% female) between January 1, 2016, and November 30, 2021. That time period included the introduction of population-wide COVID-19 restrictions from April 2020 to the latest available date of each database.
The primary outcomes were defined as yearly and monthly incidences of dementia diagnosis and the prevalence of people living with dementia who were prescribed antipsychotic drugs in each database.
The rates of antipsychotic drug prescribing for people with dementia increased in six databases representing all countries, the researchers pointed out, adding, “Compared with the corresponding month in 2019, the most pronounced increase in 2020 was observed in May in South Korea (Kangwon National University database) (RR [relative risk], 2.11; 95% CI, 1.47-3.02) and June in the UK (RR, 1.96; 95% CI, 1.24-3.09). The rates of antipsychotic drug prescribing in these six databases remained high in 2021. Interrupted time series analyses revealed immediate increases in the prescribing rate in Italy (RR, 1.31; 95% CI, 1.08-1.58) and in the U.S. Medicare database (RR, 1.43; 95% CI, 1.20-1.71) after the introduction of COVID-19 restrictions.”
The authors explained, “The COVID-19 pandemic has had profound effects on older populations worldwide. The implementation of unprecedented public health measures disrupted daily routines and support of people living with dementia, which may have aggravated behavioral and psychological symptoms of dementia. This has led to concerns that antipsychotic drug use may have increased in response to the worsening of symptoms associated with COVID-19 restrictions.”
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