Antipsychotic prescriptions for dementia soared during COVID-19 pandemic

The overall rate of antipsychotic drug prescriptions to patients with dementia increased markedly during the initial months of the COVID-19 pandemic, and did not return to prepandemic levels when the acute phase was over, a multinational network cohort study has shown.

“The implementation of unprecedented public health measures [during the COVID-19 pandemic] disrupted daily routines of and support for people with dementia,” said the researchers. Although clinical guidelines recommend using antipsychotic drugs only as the last resort in people with dementia, concerns have been raised that these drugs might have been used increasingly in dementia patients during the COVID-19 pandemic. [JAMA Psychiatry 2023;doi:10.1001/jamapsychiatry.2022.4448]

To investigate multinational trends in antipsychotic drug prescription in dementia patients before and after the COVID-19 pandemic, patients aged ≥65 years with a diagnosis of dementia (n=857,238; female, 58.0 percent) between 1 January 2016 and 31 November 2021 were identified using eight databases from six countries (ie, France, Germany, Italy, South Korea, the UK, and the US). Antipsychotic drug prescribing rates in the early phase of the pandemic (April, May, and June 2020) were compared with rates in corresponding months in 2019.

“Antipsychotic drug prescribing rates among dementia patients increased in six databases representing all countries,” reported the researchers. Among the countries studied, the most pronounced rises were observed in May 2020 in South Korea and June 2020 in the UK, approximately doubling the prescribing rates compared with the corresponding months in 2019 (South Korea KUN database: rate ratio [RR], 2.11; 95 percent confidence interval [CI], 1.47–3.02) (UK IMRD database: RR, 1.96; 95 percent CI, 1.24–3.09).

“Although specific causes for the increase in antipsychotic drug prescribing rates may vary and cannot be identified by the current data, the increase may be partly associated with both a deterioration in behavioural and psychological symptoms of dementia and reduced access to care following the introduction of COVID-19 restrictions,” explained the researchers. As indicated by interrupted times series analyses, there were immediate increases in prescribing rates in Italy’s IQVIA (RR, 1.31; 95 percent CI, 1.08–1.58) and the US MDCR (RR, 1.43; 95 percent CI, 1.20-1.71) databases after the introduction of COVID-19 containment policies.

Notably, antipsychotic drug prescribing rates did not return to prepandemic levels and remained high, according to latest available data from March to November of 2021. “This continued reliance on antipsychotic drugs suggests a substantial burden of unmet needs in dementia, and that this population faced continued challenges in care even after the acute phase of the COVID-19 pandemic,” commented the researchers.

In summary, the findings suggest that the COVID-19 pandemic disrupted the care of dementia patients, underlining the need to develop intervention strategies to ensure quality of care.