Return to the Blog

Nursing Home Antipsychotic Increased During the COVID Pandemic

Elderly man putting medication in his mouth while health care practioner hands him a glass of water.

In the acute and early stages of the COVID pandemic, prescriptions for antipsychotic drugs spiked among patients living with dementia in the U.S., as well as France, Italy, South Korea, and UK. This is the finding of Luo et al. publishing in JAMA Psychiatry, January 25, 2023 (Rates of Antipsychotic Drug Prescribing Among People Living With Dementia During the COVID-19 Pandemic). Data were collected from electronic health records and claims data from 8 databases.

The rate of antipsychotic drug prescription “did not decrease to prepandemic levels after the acute phase of the pandemic had ended,” report the researchers. “The effects of the COVID-19 pandemic on contemporary antipsychotic drug prescribing trends globally remain unclear.”

Upswing in BPSD

Why did antipsychotic use increase during COVID lockdowns? The study authors point to a number of factors: confinement; disruption of care routines; lack of social interaction from friends, family, and volunteers; and compromised nonpharmacological interventions for behavioral and psychological symptoms of dementia, say the authors. Deterioration in BPSD symptoms and reduced access to care were key.

The high rates of antipsychotic use suggest that “the burden of unmet needs in people living with dementia was substantial and that this population faced continued challenges in care even after the acute phase of the COVID-19 pandemic,” say the authors.

BSPD: “reflex” antipsychotic prescription

In an accompanying editorial, Helen C. Kales, MD and colleagues suggest that practitioners may have compensated for pandemic-related disruptions by increasing their use of psychotropic medications, which is often the go-to treatment for BPSD.

“To limit this antipsychotic-prescribing reflex, clinicians need a structured approach to their BPSD differential diagnosis to help select the most appropriate intervention, which will typically not be an antipsychotic,” the editorial said.

Dementia Care Practice Recommendations from the Alzheimer’s Association likewise advise that “antipsychotic and other psychotropic medications are generally not indicated to alleviate BPSDs,” yet the practice continues. The scope of inappropriate antipsychotic usage in nursing homes was recently catalogued in a report from the Long Term Care Community Coalition, “A Decade of Drugging” (see “Dangerous Antipsychotics” Still Prevalent in Nursing Homes).

CMS audits – schizophrenia diagnosis

Diagnosing dementia patients with schizophrenia to justify antipsychotic prescriptions is an unacceptable practice addressed in CMS surveyor guidance for nursing homes issued in June 2022. With the practice being commonplace, though, CMS announced on Jan. 18, 2023 that it will “conduct targeted, off-site audits to determine whether nursing homes are accurately assessing and coding individuals with a schizophrenia diagnosis.”

Despite the prevalence of antipsychotic use among dementia patients in nursing homes, practitioners at GuideStar Eldercare believe there is a better way to address the challenges of dementia care. Our clinical protocols begin with multidisciplinary assessment and accurate diagnosis; it is crucial to know how and why symptoms manifest before responding with prescriptions for psychotropic drugs. We support proper documentation and regulatory compliance. (Learn more about our antipsychotic stewardship program).

It is time to solve the problem of antipsychotic overuse throughout the LTC industry. Grounded in multidisciplinary expertise and a multistate practice (Illinois, Indiana, Kentucky, Michigan, Ohio, and Texas), we are here to help.