Increase in Antipsychotic Prescriptions in AL Residents with Dementia

The use of antipsychotics, antidepressants, and anticonvulsants in assisted living (AL) increased during the COVID-19 pandemic, according to new research published in JAMDA. The population-based study showed a statistically significant increase in antipsychotic and antidepressant use in residents in dementia care and other AL settings during the pandemic. Prescriptions for antipsychotics increased more than antidepressants and usage was 8% higher for those in memory care versus other AL settings.

Interestingly, there was a statistically significant decrease in the use of benzodiazepines, and no significant change — increase or decrease — in opioid use. The study authors suggested that this may signal “poorer detection and management of pain in AL residents with cognitive impairment, both before and after the pandemic.”

According to the study results, the increase of antipsychotics in memory care was actually greater than numbers reported for nursing home residents with dementia — 3.5% to 7% versus 1.7%. The authors were surprised by these findings as their hypothesis was that specialized dementia care staff and environments in AL and memory care would potentially minimize behavioral issues and antipsychotic use.

The study results, the authors said, raise alarms about the potentially increased risks from central nervous system polypharmacy and adverse health outcomes in this care setting. They concluded, “The unique challenges experienced by AL homes, both before and during the pandemic, require careful consideration and rigorous research to identify setting-specific opportunities to improve pharmacotherapy practices and policies and, ultimately, residents’ health and well-being.”