Prescribing patterns of psychotropic medications among people living with dementia after disasters

Disasters can worsen behavioral symptoms in people living with dementia, leading to disorientation, anxiety, and paranoia. In such situations, psychotropic medications may be inappropriately used to manage these symptoms. This study estimated the receipt of new, or changes to existing, psychotropic prescription medications post-disaster among fee-for-service Medicare beneficiaries with a dementia diagnosis.

Medicare administrative claims data were used to examine the relationship between hurricane exposure and receipt of antipsychotic prescriptions among people living with dementia with no prior use. The primary outcome was a daily count of new psychotropic prescriptions per beneficiary, from Part D claims, residing in exposed and unexposed counties 12 months after the hurricane landfall. The secondary outcome was a daily count of increases in the dosage of psychotropic prescriptions. Federal Emergency Management Agency disaster declarations were used to determine disaster-exposed groups.

A total of 70 307 traditional fee-for-service beneficiaries with a dementia diagnosis were included in the study. In analyses adjusted for age, sex, race/ethnicity, Part D low-income subsidy status, rurality and number of Elixhauser comorbidities conducted over a 12-month period following the three hurricanes, beneficiaries exposed to the hurricanes had a 10% higher rate of starting new antipsychotic prescriptions compared to those in unexposed counties (IRR: 1.10, 95% CI: 1.04-1.17). Analyses conducted by individual hurricanes revealed substantial differences, with higher rates of initiating antipsychotics following Hurricane Harvey (IRR: 1.21, 95% CI: 1.07-1.36), and no change after Hurricanes Irma (IRR: 0.97, 95% CI: 0.88-1.08) and Florence (IRR: 0.92, 95% CI: 0.80-1.05).

Psychotropic prescribing increased after Hurricane Harvey but not after Irma or Florence, suggesting context-specific factors may influence clinical responses during disasters. Our findings highlight the importance of incorporating person-centered care and appropriate behavioral health responses into disaster preparedness planning for the dementia population.