Evidence of increased antipsychotic medication prescription rates among individuals with dementia during COVID-19 pandemic

By Pooja Toshniwal PahariaJan 30 2023Reviewed by Aimee Molineux

In a recent study published in JAMA Psychiatry, researchers investigated global trends in the prescribing of antipsychotic medication for individuals with dementia during the pre-coronavirus disease 2019 (COVID-19) pandemic period and the pandemic period.

Background

Antipsychotic medications are often administered to individuals with dementia for psychological and behavioral symptom improvement. Health authorities across the globe have raised concerns regarding the probable increase in antipsychotic medication prescription rates among individuals with dementia during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

About the study

In the present multinational study, researchers assessed the changes in antipsychotic medication prescriptions during the SARS-CoV-2 pandemic in comparison to pre-pandemic periods globally.

The study utilized data from electronic medical records and medical claims reported in eight databases across six nations [Germany, South Korea, France, the United States (US), the United Kingdom (UK), and Italy] of individuals aged ≥65 years between 1 January 2016, and 30 November 2021. The study exposure was the implementation of COVID-19 lockdown policies for the public between April 2020 and the most recent month, up to which data were accessible in every database.

The prime outcomes of the study were the monthly and annual incidence rates for dementia and the prevalence of individuals with dementia receiving antipsychotic medications in every database. The team utilized interrupted time series analyses for quantifying changes in antipsychotic drug prescriptions during the period of COVID-19 lockdown measures and policies.

All the databases included were linked with the observational medical outcome partnership CDM (common data model) under the OHDSI (observational health data sciences and informatics) network. The present study was a component of the CERVELLO (coronavirus disease 2019 pandemic impacts on mental health-related conditions via multi-database network longitudinal observational) trial.

The electronic medical record databases for data retrieval included were the longitudinal patient database for Italy, the IQVIA longitudinal patient database for France, the IQVIA disease analyzer database for Germany, the AUSOM (Ajou university school of medicine) electronic database for South Korea, the KUN (Kangwon national university) electronic database for South Korea, and the IMRD (IQVIA medical research data) database for the United Kingdom.  

Claims data were retrieved from the IQVIA open claims database for the United States and the International business machines MarketScan medicare supplemental and coordination of benefits database for the United States. The incidence rates for dementia in 2016 were excluded from the analysis. The team performed quasi-Poisson regression modeling, and risk ratios (RR) were calculated.

Sensitivity analyses were performed by including the calendar month as a variable and repeating the analysis by considering the pre-implementation period as that between 1 January 2016 and 31 January 2020 and the post-implementation period as that between 1 March 2020 and the most recent date that data were available in the databases.

Results

The team identified 857,238 individuals with dementia aged ≥65 years in 2016, among whom most (58%) were women. Lowered dementia incidence was reported in seven databases during the initial COVID-19 wave, from April 2020 to June of the same year. The reduction in incidence was most pronounced among one of the two databases of the United States (RR 0.3).

In addition, a lower prevalence of dementia was observed during COVID-19 in Italy, France, the United States, South Korea, and the United Kingdom. The antipsychotic medication prescription rates for individuals with dementia were elevated in the databases across all nations. In comparison to May 2019, the team observed a profound rise in May of the following year in the southern parts of Korea, as reported in the KUN database (risk ratio 2.1), and during June 2020 in the United Kingdom (RR 2.0).

The antipsychotic medication prescription rates were persistently high in the following year across the databases. Immediate elevations in the rate of antipsychotic medication prescription were reported in Italy (risk ratio 1.3) and in the United States Medicare database (risk ratio 1.4) following the COVID-19 containment measures and health policies. The sensitivity analyses yielded similar findings as the main analysis.

Overall, the study findings showed increased antipsychotic medication prescription rates during the acute COVID-19 and post-acute COVID-19 periods globally, in comparison to the rates observed during the pre-pandemic period. The findings indicated that COVID-19 disrupted healthcare for individuals with dementia, underscoring the need to develop health interventions and strategies to improve the level of care provided to individuals with dementia.