Presenter: Andy Jan
Copresenter(s)/coauthor(s): James Le, David Huan
Presentation Title: Impact of COVID-19 on Psychotropic Use in the Elderly
Presenter School: Western Michigan University Homer Stryker MD SOM
Mentor: Daniel Brauner, MD
Nursing homes have been especially impacted by COVID-19 in many countries around the world. Additionally, pandemic safety measures have increased staff burden and decreased availability of non-pharmacological interventions for mental health issues. A gap exists in our knowledge of the actual care provided by nursing homes during the COVID pandemic. Two areas we wanted to investigate were psychological health and psychotropic use in nursing home residents after onset of quarantine measures compared to before the pandemic.
To review medical literature from Feb 26, 2020 – Feb 26, 2021 on COVID and older persons and summarize the impact on psychological health and psychotropic usage in nursing homes in preparation for a Kalamazoo study.
A PubMed search was performed using the terms “pandemic (1) OR COVID (2)” AND “elderly (3) OR aging (4) OR dementia (5)” generating 2,947 results. Inclusion criteria required at least 2 of 5 of the aforementioned terms and specific mention of psychotropic drug use. We closely read 28 papers, 14 found by the original search and 14 found from referencing the original 14’s bibliography sections. We closely examined the mental health impact and use of psychotropic drugs to discern important themes.
The review identified four papers that reported on increased psychotropic use in nursing home patients following onset of the COVID pandemic.
Several countries are represented in these studies, with one study performed in Canada, one in Argentina, and two in Italy.
13 / 28 papers discussed the vulnerability of elderly patients to pandemic-related psychiatric morbidity.
One additional study in England found a substantial increase in the proportion of patients with dementia prescribed antipsychotics after adjusting for the increased death rate of patients with dementia during the COVID-19 pandemic.
Dementia was one of the most common comorbidities (11.9%, 46%) among COVID-19 positive deceased patients (1,2).
Apathy, anxiety, and agitation in patients with dementia were the most frequent neuropsychiatric symptoms during COVID (3).
Managing neuropsychiatric symptoms in patients with dementia was challenging during COVID given isolation from family visitors and deficiency in ability to implement non-pharm treatment for behavioral symptoms (4).
Evidence suggests that anxiety, insomnia, use of psychotropic medication, and drug misuse are rising during the current pandemic (5).
A systematic literature review suggests an increase in psychotropic prescription among elderly individuals during the COVID-19 pandemic
Evidence from papers reviewed suggests that the pandemic has introduced widespread mental health challenges, including:
Forced social distancing and isolation
Decreased rehabilitation services
Limited typical daily activities
Increased stress of family caregivers
Increased pandemic-related challenges are reported to increase rates of psychiatric disorders among the elderly, including:
Post-traumatic stress disorder
Findings from the available literature warrant further research into changes in psychotropic usage within nursing homes in Kalamazoo, Michigan
Over the next few months, we plan to investigate how prescription of psychotropics in Kalamazoo nursing homes has changed before and after the onset of the COVID-19 pandemic