This study examined associations of COVID-19 mortality rates, staffing, and resident behavior with changes in antidementia and psychotropic medication initiation among nursing home (NH) residents with dementia. A nationally representative survey of Directors of Nursing was analyzed to assess changes in medication initiation at the peak of the pandemic. NHs with higher COVID-19 mortality rates were less likely to report increases in antidementia medication initiation. COVID-19 mortality rates were not associated with significant increases or decreases in psychotropic initiation. NH’s that reported increased resident behavioral problems during the pandemic had higher odds of psychotropic initiation. In summary, NHs most affected by COVID-19 deaths were less likely than NHs with a milder pandemic experience to increase initiation of antidementia medications. Increased behavioral symptoms, possibly due to consequences of COVID-19, were associated with more psychotropic drug use. More research is needed to understand factors influencing prescribing practices during public health emergencies.
BrandtN.ChouJ. (2020). Optimizing medication management during the COVID-19 pandemic: It takes a village. Journal of Gerontological Nursing, 46(7), 3–8. https://doi.org/10.3928/00989134-20200605-02
2.
CagninA.Di LorenzoR.MarraC.BonanniL.CupidiC.LaganaV.RubinoE.VaccaA.ProveroP.IsellaV.VanacoreN.AgostaF.AppollonioI.CaffarraP.PettenuzzoI.SambatiR.QuarantaD.GuglielmiV.LogroscinoG.SINdem COVID-19 Study Group. (2020). Behavioral and psychological effects of coronavirus disease-19 quarantine in patients with dementia. Frontiers in Psychiatry, 11, 1–15. https://doi.org/10.3389/fpsyt.2020.578015
3.
CampitelliM. A.BronskillS. E.MaclaganL. C.HarrisD. A.CottonC. A.TadrousM.GruneirA.HoganD. B.MaxwellC. J. (2021). Comparison of medication prescribing before and after the COVID-19 pandemic among nursing home residents in Ontario, Canada. JAMA Network Open, 4(8), Article e2118441. https://doi.org/10.1001/jamanetworkopen.2021.18441
ChenA. T.YunH.RyskinaK. L.JungH. (2021). Nursing home characteristics associated with resident COVID-19 morbidity in communities with high infection rates. JAMA Network Open, 4(3), Article e211555. https://doi.org/10.1001/jamanetworkopen.2021.1555
CioltanH.AlshehriS.HoweC.LeeJ.FainM.EngH.SchachterK.MohlerJ. (2017). Variation in use of antipsychotic medications in nursing homes in the United States: A systematic review. BMC Geriatrics, 17(32), 32. https://doi.org/10.1186/s12877-017-0428-1
10.
CoeA. B.MontoyaA.ChangC. H.ParkP. S.BynumJ. P. W.ShiremanT. I.ZhangT.McCreedyE. M.GerlachL. B. (2023). Behavioral symptoms, depression symptoms, and medication use in Michigan nursing home residents with dementia during COVID-19. Journal of the American Geriatrics Society, 71(2), 414–422. https://doi.org/10.1111/jgs.18116
DerrettS.GunterK. E.SamaranayakaA.SingerS. J.NoconR. S.QuinnM. T.BrehenyM.CampbellA.SchaeferC. T.HeuerL. J.ChinM. H. (2019). Development and testing of the provider and staff perceptions of integrated care (PSPIC) survey. Medical Care Research and Review: MCRR, 76(6), 807–829. https://doi.org/10.1177/1077558717745936
13.
DubéC. E.NielsenN.McPhillipsE.Lee HargravesJ.CosenzaC.JesdaleB.LapaneK. L. (2023). U.S. nursing home leadership experiences with COVID-19 and its impact on residents and staff: A qualitative analysis. PLoS One, 18(12), Article e0293336. https://doi.org/10.1371/journal.pone.0293336
FillitH. M.DoodyR. S.BinasoK.CrooksG. M.FerrisS. H.FarlowM. R.LeiferB.MillsC.MinkoffN.OrlandB.ReichmanW. E.SallowayS. (2006). Recommendations for best practices in the treatment of Alzheimer’s disease in managed care. The American Journal of Geriatric Pharmacotherapy, 4(1), S9–S24. https://doi.org/10.1016/j.amjopharm.2006.10.001
16.
FrankenthalD.Zandman-GoddardG.Ben-MuvharY.Porat-KatzB. S. (2016). The impact of facility characteristics on the use of antipsychotic medications in nursing homes: A cross-sectional study. Israel Journal of Health Policy Research, 5(12), 12. https://doi.org/10.1186/s13584-016-0070-y
17.
GilstrapL.ZhouW.AlsanM.NandaA.SkinnerJ. S. (2022). Trends in mortality rates among Medicare enrollees with Alzheimer disease and related dementias before and during the early phase of the COVID-19 pandemic. JAMA Neurology, 79(4), 342–348. https://doi.org/10.1001/jamaneurol.2022.0010
18.
GiriS.ChennL. M.Romero-OrtunoR. (2021). Nursing homes during the COVID-19 pandemic: A scoping review of challenges and responses. European Geriatric Medicine, 12(6), 1127–1136. https://doi.org/10.1007/s41999-021-00531-2
19.
GorgesR. J.KonetzkaR. T. (2021). Factors associated with racial differences in deaths among nursing home residents with COVID-19 infection in the US. JAMA Network Open, 4(2), Article e2037431. https://doi.org/10.1001/jamanetworkopen.2020.37431
20.
HowardR.BurnsA.SchneiderL. (2020). Antipsychotic prescribing to people with dementia during COVID-19. The Lancet Neurology, 19(11), 892. https://doi.org/10.1016/S1474-4422(20)30370-7
21.
HughesC. M.LapaneK. L.MorV. (2000). Influence of facility characteristics on use of antipsychotic medications in nursing homes. Medical Care, 38(12), 1164–1173. https://doi.org/10.1097/00005650-200012000-00003
22.
JuC.LauW. C. Y.HayesJ. F.OsbornD.ManK. K. C.ChanE. W.WongI. C. K.WeiL. (2021). Impact of the COVID-19 pandemic on use of anti-dementia medications in 34 European and North American countries. Alzheimer’s and Dementia, 7(1), Article e12206. https://doi.org/10.1002/trc2.12206
23.
KleijerB. C.van MarumR. J.FrijtersD. H. M.JansenmP. A. F.RibbeM. W.EgbertsA. C. G.HeerdinkE. R. (2014). Variability between nursing homes in prevalence of antipsychotic use in patients with dementia. International Psychogeriatrics, 26(3), 363–371. https://doi.org/10.1017/S1041610213002019
24.
LapaneK.OttB. R.HargravesC. C.LiangS.AlcuskyM. (2024). Changes in antidementia medications upon admission to the nursing home: Who decides and why? Results from a national survey of nursing home administrators. Journal of the American Medical Directors Association, 25(1), 41–46. https://doi.org/10.1016/j.jamda.2023.09.022
25.
LiY.CenX.CaiX.Temkin-GreenerH. (2020). Racial and ethnic disparities in COVID-19 infections and deaths across U.S. nursing homes. Journal of the American Geriatrics Society, 68(11), 2454–2461. https://doi.org/10.1111/jgs.16847
26.
LiuK. Y.HowardR.BanerjeeS.Comas-HerreraA.GoddardJ.KnappM.LivingstonG.ManthorpeJ.O’BrienJ. T.PatersonR. W.RobinsonL.RossorM.RoweJ. B.SharpD. J.SommerladA.Suárez-GonzálezA.BurnsA. (2021). Dementia wellbeing and COVID-19: Review and expert consensus on current research and knowledge gaps. International Journal of Geriatric Psychiatry, 36(11), 1597–1639. https://doi.org/10.1002/gps.5567
27.
LiuN.SunJ.WangX.ZhaoM.HuangQ.LiH. (2020). The impact of dementia on the clinical outcome of COVID-19: A systematic review and meta-analysis. Journal of Alzheimer’s Disease: JAD, 78(4), 1775–1782. https://doi.org/10.3233/JAD-201016
28.
MattinglyT. J. (2015). A review exploring the relationship between nursing home staffing and antipsychotic medication use. Neurology and Therapy, 4(2), 169–175. https://doi.org/10.1007/s40120-015-0032-2
OttB. R.HollinsC.TjiaJ.BaekJ.ChenQ.LapaneK.AlcuskyM. (2023). Antidementia medication use in nursing home residents. Journal of Geriatric Psychiatry and Neurology, 37(3), 194–205. https://doi.org/10.1177/08919887231202948
31.
PhelanA.DalyL.CoffeyA.KentS.NaughtonC.TuohyD.RyanA.ByrneM. (2022). Experiences of directors of nursing in preparing for and managing Covid-19 in care homes for older people. Trinity Centre for Practice and Healthcare Innovation. https://www.tcd.ie/tcphi/assets/pdf/experienceofdons-carehomes-covid.pdf
RatajA.AlcuskyM.BaekJ.OttB.LapaneK. L. (2024). Geographic variation of antidementia and antipsychotic medication use among U.S. nursing home residents with dementia. Medical Care, 62(8), 511–520. https://doi.org/10.1097/MLR.0000000000002016
34.
ShahimB.XuH.HaugaaK.ZetterbergH.JurgaJ.ReligaD.EriksdotterM. (2024). Cholinesterase inhibitors are associated with reduced mortality in patients with Alzheimer’s disease and previous myocardial infarction. European Heart Journal. Cardiovascular Pharmacotherapy, 10(2), 128–136. https://doi.org/10.1093/ehjcvp/pvad102
35.
SiegelE. O.BettegaK.BakerjianD.SikmaS. (2018). Leadership in nursing homes: Directors of nursing aligning practice with regulations. Journal of Gerontological Nursing, 44(6), 10–14. https://doi.org/10.3928/00989134-20180322-03
36.
SimõesJ.SobieraiL.LealI.Dos SantosM.CoiadoJ.BagatiniM. (2023). Action of the purinergic and cholinergic anti-inflammatory pathways on oxidative stress in patients with Alzheimer’s disease in the context of the COVID-19 pandemic. Neuroscience, 512(21), 110–132. https://doi.org/10.1016/j.neuroscience.2022.12.007
37.
StallN. M.ZipurskyJ. S.RangrejJ.JonesA.CostaA. P.HillmerM. P.BrownK. (2021). Assessment of psychotropic drug prescribing among nursing home residents in Ontario, Canada, during the COVID-19 pandemic. JAMA Internal Medicine, 181(6), 861–863. https://doi.org/10.1001/jamainternmed.2021.0224
38.
StevensonD. G.BuschA. B.ZarowitzB. J.HuskampH. A. (2022). Psychotropic and pain medication use in nursing homes and assisted living facilities during COVID-19. Journal of the American Geriatrics Society, 70(5), 1345–1348. https://doi.org/10.1111/jgs.17739
39.
TruongC.RectoC.LafontC.Canoui-PoitrineF.BelminJ.Lafuente-LafuenteC. (2022). Effect of cholinesterase inhibitors on mortality in patients with dementia. Neurology, 99(20), e2313–e2325. https://doi.org/10.1212/WNL.0000000000201161
40.
UriguenA. F.LucasE. L.MenicucciC. S.ArrecheaI. I.TruebaJ. A.OrellaE. E.GoikouriaJ. G.TelleriaI. B. (2022). Psychotropic drug prescription in nursing homes during the COVID-19 pandemic. Drugs & Aging, 39(6), 467–475. https://doi.org/10.1007/s40266-022-00948-9
41.
WhiteE. M.WetleT. F.ReddyA.BaierR. R. (2020). Front-line nursing home staff experiences during the COVID-19 pandemic. Journal of the American Medical Directors Association, 22(1), 199–203. https://doi.org/10.1016/j.jamda.2020.11.022
42.
XuH.Garcia-PtacekS.JönssonL.WimoA.NordströmP.EriksdotterM. (2021). Long-term effects of cholinesterase inhibitors on cognitive decline and mortality. Neurology, 96(17), e2220–e2230. https://doi.org/10.1212/WNL.0000000000011832
43.
YanD.Temkin-GreenerH.CaiS. (2023). Did the COVID-19 pandemic affect the use of antipsychotics among nursing home residents with ADRD?The American Journal of Geriatric Psychiatry, 31(2), 124–140. https://doi.org/10.1016/j.jagp.2022.09.009
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