Antipsychotic use in people with dementia living in care homes rose during COVID-19 pandemic

Data show the rate of antipsychotic prescribing rose from 18% of people with dementia in care homes before the pandemic to 28% of people during the pandemic.
Care home staff wearing full PPE while checking on a patient

Prescribing of antipsychotic drugs to people with dementia living in care homes rose significantly during the COVID-19 pandemic, according to research from the University of Exeter and King’s College London.

The research, presented at the Alzheimer’s Association International Conference — held from 31 July to 4 August 2022 in San Diego, California, compared rates of prescribing of antipsychotics in UK care homes in 2016/2017 and 2021/2022.

The researchers found that the antipsychotic prescribing rate rose from 18% of people with dementia in care homes before the pandemic in 2016/2017, to 28% of people in care homes with dementia in 2021/2022 during the pandemic.

In more than a third of care homes, more than half of people with dementia were receiving antipsychotic drugs during the pandemic, the researchers found.

The study used data from the iWHELD programme, which is conducting clinical trials to support care homes to improve the wellbeing of patients with dementia.

The research team used baseline prescribing data gathered from 971 residents across 69 nursing homes in 2016/2017, and from 747 residents across 149 nursing homes in 2021/2022.

Researchers said the rates of neuropsychiatric symptoms, such as agitation and depression, were similar in the two cohorts and that there were fewer people with severe dementia in the later group.

However, when they analysed nursing homes with higher levels of antipsychotic prescriptions, they found that they reported higher levels of neuropsychiatric symptoms and also higher levels of staff sickness.

Antipsychotic drugs are used to treat behavioural and psychological symptoms of dementia, including agitation and psychosis. However, their use for people with dementia has been discouraged in recent decades, after research showed that they significantly increase the risk of side effects, including stroke, in this population.

Commenting on the study, David Taylor, head of pharmacy at the Maudsley Hospital, a psychiatric hospital in south London, said the figures showed “desperation” among clinicians.

“Antipsychotics have disputed and marginal therapeutic benefits in older people with dementia and have rather more definite adverse effects,” he said.

“Almost any use of these drugs in older people should be condemned. An increase in their use suggests both a catastrophic failure of education and a level of desperation amongst clinicians.”

Study co-lead Clive Ballard, pro-vice chancellor and executive dean at the University of Exeter Medical School, said the pressures of COVID-19 in care homes were likely to blame for the rise in antipsychotic use. Some 64% of nursing homes studied in 2021/2022 had experienced COVID-19 outbreaks.

“COVID-19 put tremendous pressure on care homes, and the majority of them must be applauded for maintaining relatively low antipsychotic prescribing levels amid incredibly difficult circumstances,” he said.

“However, there were very significant rises in antipsychotic prescribing in one third of care homes and we urgently need to find ways to prioritise support to prevent people with dementia being exposed to significant harms.”

Last updated
The Pharmaceutical Journal, PJ, August 2022, Vol 309, No 7964;309(7964)::DOI:10.1211/PJ.2022.1.153179

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