Behavioral symptoms of dementia and psychotropic use during the COVID-19 pandemic

As nursing home settings and their residents were severely affected by the COVID-19 pandemic, changes in care practices along with increased social isolation during the pandemic may have increased the prevalence of behavioral and psychological symptoms of dementia (BPSD) and psychotropic medication use in nursing homes.

We conducted a repeated cross-sectional study using 2019 and 2020 Minimum Data Set from nursing homes in New York, Utah, and Colorado. The primary outcome was a composite BPSD measure, defined as two or more symptoms among depression, wandering, rejection of care, hallucinations, delusions, or verbal/physical behavioral symptoms. Secondary outcomes included neuropsychiatric sub-syndromes and psychotropic use.

From 2019 to 2020, the prevalence of two or more BPSDs increased from 19.0% (95% CI, 18.8-19.2) to 20.2% (95% CI, 20.0-20.5). Increases in BPSD were largely driven by depressive symptoms, which increased by 63%, from 17.4% (95%CI, 17.1-17.6) in 2019 to 28.3% (95%CI, 28.0-28.5) in 2020. Whereas, the prevalence of psychosis-related symptoms changed minimally, from 5.6% (95%CI, 5.5-5.8) to 5.7% (95%CI, 5.5-5.8), and agitation-related symptoms decreased from 30.0% (95%CI, 29.8-30.3) in 2019 to 29.6% (95%CI, 29.4-30.0) in 2020. Antipsychotic and sedative use decreased while antidepressant and antianxiety use remained steady.

In this study of nursing home residents, the prevalence of BPSD was higher during the COVID-19 pandemic, primarily driven by increased depressive symptoms. These findings underscore the need to strengthen depression screening and mental health support for nursing home residents during public health emergencies such as pandemics.