The course of neuropsychiatric symptoms and psychotropic drug use in Dutch nursing home patients with dementia during the first wave of COVID‐19: A longitudinal cohort study

Sizoo, Eefje M.; Thunnissen, Josi A.; Loon, Anouk M. van; Brederveld, Claire L.; Timmer, Helma; Hendriks, Simone A.; Smalbrugge, Martin

doi:10.1002/gps.5693

Cited by 13 publications

(10 citation statements)

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“…However, these findings are limited by the short observational periods both before and after the introduction of health and containment policies. Studies conducted in Argentina and the Netherlands, both in mid-2020, had small samples, did not have prepandemic data, were limited to a specific setting, or used self-reported survey data . The effects of the COVID-19 pandemic on contemporary antipsychotic drug prescribing trends globally remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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Rates of Antipsychotic Drug Prescribing Among People Living With Dementia During the COVID-19 Pandemic

et al. 2023

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ImportanceConcerns have been raised that the use of antipsychotic medication for people living with dementia might have increased during the COVID-19 pandemic.ObjectiveTo examine multinational trends in antipsychotic drug prescribing for people living with dementia before and during the COVID-19 pandemic.Design, Setting, and ParticipantsThis multinational network cohort study used electronic health records and claims data from 8 databases in 6 countries (France, Germany, Italy, South Korea, the UK, and the US) for individuals aged 65 years or older between January 1, 2016, and November 30, 2021. Two databases each were included for South Korea and the US.ExposuresThe introduction of population-wide COVID-19 restrictions from April 2020 to the latest available date of each database.Main Outcomes and MeasuresThe main outcomes were yearly and monthly incidence of dementia diagnosis and prevalence of people living with dementia who were prescribed antipsychotic drugs in each database. Interrupted time series analyses were used to quantify changes in prescribing rates before and after the introduction of population-wide COVID-19 restrictions.ResultsA total of 857 238 people with dementia aged 65 years or older (58.0% female) were identified in 2016. Reductions in the incidence of dementia were observed in 7 databases in the early phase of the pandemic (April, May, and June 2020), with the most pronounced reduction observed in 1 of the 2 US databases (rate ratio [RR], 0.30; 95% CI, 0.27-0.32); reductions were also observed in the total number of people with dementia prescribed antipsychotic drugs in France, Italy, South Korea, the UK, and the US. Rates of antipsychotic drug prescribing for people with dementia increased in 6 databases representing all countries. 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, 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 6 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 US Medicare database (RR, 1.43; 95% CI, 1.20-1.71) after the introduction of COVID-19 restrictions.Conclusions and RelevanceThis cohort study found converging evidence that the rate of antipsychotic drug prescribing to people with dementia increased in the initial months of the COVID-19 pandemic in the 6 countries studied and did not decrease to prepandemic levels after the acute phase of the pandemic had ended. These findings suggest that the pandemic disrupted the care of people living with dementia and that the development of intervention strategies is needed to ensure the quality of care.

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Section: Introductionmentioning

confidence: 99%

“…Studies conducted in Argentina and the Netherlands, both in mid-2020, had small samples, did not have prepandemic data, were limited to a specific setting, or used selfreported survey data. 9,10 The effects of the COVID-19 pandemic on contemporary antipsychotic drug prescribing trends globally remain unclear.…”

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confidence: 99%

Rates of Antipsychotic Drug Prescribing Among People Living With Dementia During the COVID-19 Pandemic

et al. 2023

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“…Sizoo et al (2022) investigated antipsychotic prescribing rates in psychogeriatric residents with dementia in the Netherlands, before and during national lockdowns. 26 The proportion of people prescribed an antipsychotic was high (21•0-22•9%), reflecting the known higher rates of antipsychotic use in care home populations. They did not identify a change in prescribing practices over the study period.…”

Section: Antipsychotic Prescribing Before and During The Covid-19 Pan...mentioning

confidence: 99%

Antipsychotic prescribing and mortality in people with dementia before and during the COVID-19 pandemic: retrospective cohort study

Schnier

McCarthy

Moralès

et al. 2023

Preprint

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Background: Antipsychotic drugs have been associated with increased mortality, stroke and myocardial infarction in people with dementia. Concerns have been raised that antipsychotic prescribing may have increased during the COVID-19 pandemic due to social restrictions imposed to limit the spread of the virus. We used multisource, routinely-collected healthcare data from Wales, UK, to investigate prescribing and mortality trends in people with dementia before and during the COVID-19 pandemic. Methods: We used individual-level, anonymised, population-scale linked health data to identify adults aged >=60 years with a diagnosis of dementia in Wales, UK. We explored antipsychotic prescribing trends over 67 months between 1st January 2016 and 1st August 2021, overall and stratified by age and dementia subtype. We used time series analyses to examine all-cause, myocardial infarction (MI) and stroke mortality over the study period and identified the leading causes of death in people with dementia. Findings: Of 57,396 people with dementia, 11,929 (21%) were prescribed an antipsychotic at any point during follow-up. Accounting for seasonality, antipsychotic prescribing increased during the second half of 2019 and throughout 2020. However, the absolute difference in prescribing rates was small, ranging from 1253 to 1305 per 10,000 person-months. Prescribing in the 60-64 age group and those with Alzheimer's disease increased throughout the 5-year period. All-cause and stroke mortality increased in the second half of 2019 and throughout 2020 but MI mortality declined. From January 2020, COVID-19 was the second commonest underlying cause of death in people with dementia. Interpretation: During the COVID-19 pandemic there was a small increase in antipsychotic prescribing in people with dementia. The long-term increase in antipsychotic prescribing in younger people and in those with Alzheimer's disease warrants further investigation. Funding: British Heart Foundation (BHF) (SP/19/3/34678) via the BHF Data Science Centre led by HDR UK, and the Scottish Neurological Research Fund.

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“… 6 , 7 However, the isolation associated with infection control and restrictions on interactions with family members have caused a decline in the physical function and worsening of dementia symptom in older PWD. 8 , 9 Although remote interaction and cognitive and physical stimulation training have been implemented in many facilities, people with severe dementia have difficulties in understanding remote communication and gaining familiarity with the process. 10 A flexible combination of remote and face‐to‐face forms of communication comprising a small number of people while maintaining physical distance could be a more viable solution for PWD.…”

Section: Figurementioning

confidence: 99%

Restrictions on visits and outings in geriatric care facilities during the COVID‐19 pandemic

Kazawa

Kubo

Akishita

et al. 2022

Geriatrics Gerontology Int

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The course of neuropsychiatric symptoms and psychotropic drug use in Dutch nursing home patients with dementia during the first wave of COVID‐19: A longitudinal cohort study

Cited by 13 publications

References 31 publications

Rates of Antipsychotic Drug Prescribing Among People Living With Dementia During the COVID-19 Pandemic

Rates of Antipsychotic Drug Prescribing Among People Living With Dementia During the COVID-19 Pandemic

Antipsychotic prescribing and mortality in people with dementia before and during the COVID-19 pandemic: retrospective cohort study

Restrictions on visits and outings in geriatric care facilities during the COVID‐19 pandemic

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