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Change in Distressed Behavior in Dementia During the COVID-19 Pandemic in Veterans Affairs Community Living Centers
Thomas A Bayer1, Frank DeVone2, Mriganka Singh1
1VA Transformative Health Systems Research to Improve Veteran Equity and Independence (THRIVE) Center of Innovation, Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
Objectives:
To compare distressed behavior in Veterans with Alzheimer disease and related dementias (ADRD) residing in Veterans Affairs (VA) Community Living Centers (CLCs) during the COVID-19 pandemic to previous years.
Design:
Retrospective cohort study.
Setting And Participants:
Veterans with ADRD and without baseline distressed behavior residing in CLCs in March 2020 (Early-COVID) and March 2018 or March 2019 (Pre-COVID).
Methods:
We measured distressed behavior with the Distressed Behaviors in Dementia Indicator. Using a Cox regression, we compared the 180-day hazard of distressed behavior in the Early-COVID group to that in the Pre-COVID group.
Results:
Of 4383 sampled Veterans, 1190 (27%) had recently taken an antipsychotic medication. In the Pre-COVID (n = 2795) and Early-COVID groups (n = 1588), new distressed behavior occurred in 629 (22.5%) and 313 (19.7%) Veterans, respectively. The adjusted hazard ratio (HR) of new distressed behavior was 0.82 (95% CI 0.71-0.95) for Early-COVID compared with Pre-COVID. Antipsychotic medication was associated with new distressed behavior (HR 1.61, 95% CI 1.40-1.86).
Conclusions And Implications:
New distressed behavior decreased during the first 6 months of the COVID-19 pandemic compared with the previous 2 years. The observed association between antipsychotic medication use and distressed behavior may reflect clinical recognition and treatment of a predisposition toward distressed behavior. Recorded changes in distressed behavior in Veterans with dementia residing in CLCs opposed the trend of decreased well-being in residents of non-VA nursing homes, but changes in resident assessment fidelity during the Early-COVID period could have confounded the study.
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