The prescribing of antipsychotic medications in assisted living communities and nursing homes has increased by 1.5% since the beginning of the COVID-19 pandemic, according to a recent study.
The findings raise questions about the short- and long-term effects on the quality of care and health outcomes for residents, according to the authors. The investigators did not separate findings by setting in the study, from the U. S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation.
Reducing off-label use of antipsychotics in assisted living communities has been a goal of the industry. A new assisted living community accreditation program launched last year by The Joint Commission is using medication management — specifically off-label antipsychotic drug use — as one of its performance measures. The National Center for Assisted Living’s Quality Initiative also considers antipsychotic medication use among its criteria. Recent years’ criteria for award recipients have included the use of off-label antipsychotic medications in 15% of residents or less.
Highest at beginning of pandemic
According to the HHS study, the highest increase in the number of prescriptions dispensed occurred during the first quarter of the pandemic in 2020, with a 7.4% increase compared with the first quarter 2019.
During this time, researchers noted, long-term care facilities were experiencing a disproportionately high number of COVID-19 infections and deaths, as uncertainty remained about the virus and infection control measures. The situation, they said, was compounded by a lack of personal protective equipment, staffing shortages and new governmental requirements for isolation and the limiting of in-person visits.
“These added challenges disrupted care in many facilities, likely affecting residents’ physical, mental and behavioral health, which may have influenced changes in care practices, including medication prescribing,” the study authors wrote.
After this initial increase, the quarterly number of prescriptions for antipsychotic medications dropped close to pre-pandemic levels, despite the declining long-term care facility resident census overall.
Increases in 2020 and 2021
The researchers also found the number of prescriptions dispensed for four of the five most frequently prescribed antipsychotics in long-term care facilities increased in both 2020 and 2021, compared with pre-pandemic levels.
Aripiprazole, used to treat schizophrenia, had the largest increase compared with 2019 levels, at 14% in the first quarter 2020. The drug also has been used in long-term care facilities to manage behavioral and psychological symptoms of dementia and to manage chronic conditions, including depression and bipolar disorder.
The growth in antipsychotic prescribing in long-term care facilities during the pandemic raises concerns and warrants further investigation into the reasons for the changes, disparities in prescribing by facility and resident characteristics, in addition to its effects on resident care and health outcomes, according to the investigators.
Other research
The results are somewhat in line with those from a study published by the Journal of the American Geriatrics Society that McKnight’s Senior Living previously reported. In that study, investigators found that the use of antipsychotics and pain medications in assisted living and nursing home residents was relatively unchanged between January 2019 and August 2020.
Another study published last month in Frontiers in Medicine reported that pre-COVID-19 psychotropic medication use was associated with post-COVID dementia in older adults.
