Abstract
Introduction: Evidence is contradictory on the impact of the COVID-19 pandemic and imposed restrictions on psychotropic medication use among people with dementia. This study examined prescribing trends of psychotropic medications (antipsychotics, antidepressants, hypnotics and anxiolytics, antiepileptics) before and after pandemic onset, among care home residents with dementia in Northern Ireland. Methods: Medication data from a population-wide prescribing database were linked with demographic and care home data from administrative records. Participants included individuals living in a care home categorised as providing dementia care to whom a medication indicated for dementia management was dispensed. Monthly prescription uptake was examined over two phases (pre-pandemic: January 2018-February 2020; during the pandemic: March 2020-December 2022). Time series autoregressive integrated moving average (ARIMA) analysis was performed in R; expected monthly values were compared with actual values, stratified by resident and care home characteristics. Results: The study included 7,544 participants; the majority were female (n=4,967, 65.8%) and aged ≥75 years (n=6,659, 88.2%). Over the study period, 70.5% of participants were in receipt of a psychotropic medication pre-pandemic, increasing to 72.4% during the pandemic. Antipsychotic medication uptake followed an upward trend during the pandemic. It was statistically significantly higher than expected forecast values in January, March, and December 2021, and uptake was higher than expected amongst males, those aged ≥85 years, and those living in care homes located in rural areas. Antidepressant medication uptake was lower than expected in females, those aged 65-74 and ≥85 years, and those living in care homes located in urban areas and in residential homes. Uptake of hypnotic, anxiolytic and antiepileptic medications were largely unchanged during the study period. Conclusion: These findings highlight changes in the use of psychotropic medications among RwD during the pandemic, notably antipsychotics and antidepressants. Regular monitoring and review of psychotropic medications is warranted to reduce medication-related harm.