Luo H, Lau WC, Chai Y, Torre CO, Howard R, Liu KY, Lin X, Yin C, Fortin S, Kern DM, Lee DY, Park RW, Jang JW, Chui CS, Li J, Reich C, Man KK, Wong IC. Rates of Antipsychotic Drug Prescribing Among People Living With Dementia During the COVID-19 Pandemic. JAMA Psychiatry. 2023 Mar 1;80(3):211-219. PubMed.

Recommends

Please login to recommend the paper.

Comments

  1. I don’t think I see what the authors claim about antipsychotics for dementia. The U.S. data is different from the ex-U.S. The two U.S. databases show decreases in dementia diagnoses in 2020, especially during the spring, followed by compensatory increases in 2021. Not a surprise. You can’t get a dementia diagnosis if you are isolated and can’t see your doctor.

    Second, antipsychotic prescribing rates trended differently in each U.S. database. The prevalence rates of prescriptions were constant in the U.S. open claims database, between 17.58 percent and 17.94 percent in the four years before 2020. It then bumped slightly to 18.26 percent in 2020 and 19.12 percent in 2021. The smaller Medicare supplemental database showed a similar bump from 19.81 percent in 2019 to 20.42 percent in 2020. But then there was a drop to 18.67 percent that was lower than the previous five years. So, it seems rates decreased twice as much as they increased in the claims database.

    Both diagnoses and antipsychotics prescribing look to me like perturbations due to the isolation and deaths of older folk during the first year of the pandemic. The deaths and increased morbidity seem as much due to lack of care as they are to COVID directly, which is part of the tragedy of this epidemic. It’s a mistake, however, to rely on antipsychotic prescribing as an index of poor care. Over the many years of administrative efforts to reduce antipsychotic prescribing to people with dementia, other drugs such as antidepressants (e.g., citalopram), anticonvulsants (e.g., gabapentin), and analgesics including opiates have to a large extent replaced antipsychotics as tools to suppress disruptive behavior. Tracking antipsychotic use for people with dementia doesn’t give us enough of the story.

    References:

    Gerlach LB, Maust DT, Kales HC, Chang M, Kim HM, Wiechers IR, Zivin K. Evaluation of Antipsychotic Reduction Efforts in Patients With Dementia in Veterans Health Administration Nursing Homes. Am J Psychiatry. 2022 Aug;179(8):544-552. Epub 2022 May 26 PubMed.

    Schneider LS. The Safety of Pimavanserin for Parkinson's Disease and Efforts to Reduce Antipsychotics for People With Dementia. Am J Psychiatry. 2022 Aug;179(8):519-521. PubMed.

    View all comments by Lon S. Schneider

  2. This is a substantial and important study showing sustained increases in antipsychotic prescribing for people with dementia. It also accords with our own nursing home studies showing a 30 percent increase in prescribing of antipsychotics over the same period. It is important to remind ourselves of the associated harms of antipsychotics for people with dementia including major morbidities, mortality and quality of life. Urgent action is needed to begin to reintroduce the practice measures that have previously been effective internationally in bringing about a 30 to 50 percent reduction in antipsychotic prescribing for people with dementia.

    View all comments by Clive Ballard

Make a Comment

To make a comment you must login or register.

This paper appears in the following:

News

  1. Did Dementia Patient Care Go Downhill During the COVID Pandemic?