Pandemic Brought Marked Increase in Antipsychotic Prescribing in Nursing Homes

The overall proportion of nursing home residents with dementia treated with antipsychotics rose from a prepandemic 18% to 32% during the pandemic, according to a study of UK nursing homes published online in the International Journal of Geriatric Psychiatry.

“There has been a significant increase in antipsychotic prescribing in nursing homes since the COVID-19 pandemic, with a disproportionate rise in one-third of homes, where median prescription rates for antipsychotics were almost 60%,” wrote Clive Ballard of the University of Exeter Medical School in the United Kingdom and coauthors.

The analysis compared baseline data from 2 large nursing home studies. Specifically, researchers looked at data on neuropsychiatric symptoms and antipsychotic use in 666 participants from 149 nursing homes from the Improving Well Being and Health in People with Dementia (WHELD) study, conducted in 2015–2016, and 1006 participants from 69 nursing homes from the COVID-Improving Well Being and Health in People with Dementia (COVID-iWHELD) study from 2020 to 2022.

Although the prevalence of neuropsychiatric symptoms in patients with dementia did not change, antipsychotic prescribing grew from 18% from the prepandemic study to 32% during the pandemic study.

“At a nursing home level, the medians for the low, medium and high tertiles for antipsychotic use were 7%, 20% and 59% respectively,” researchers reported, “showing a disproportionate rise in tertile three.”

Data showed a small but significant increase in agitation among residents with dementia in the third of nursing homes with the highest rates of antipsychotic prescribing, according to the study. 

“Strategies are urgently needed to identify these nursing homes and introduce proactive support to bring antipsychotic prescription rates back to prepandemic levels,” researchers advised.

Reference:
McDermid J, Ballard C, Khan Z, et al. Impact of the COVID-19 pandemic on neuropsychiatric symptoms and antipsychotic prescribing for people with dementia in nursing home settings. Int J Geriatr Psychiatry. Published online January 16, 2023. doi:10.1002/gps.5878