Zhang T, Santostefano CM, Harris D, Coe AB, Zullo AR, Gerlach LB, Joshi R, Bynum JPW, Shireman TI
Abstract
Objectives: To estimate the immediate and long-term effects of a visitor restriction policy on antipsychotic use in nursing home (NH) residents with Alzheimer's disease and related dementias (ADRD) during COVID-19.
Design: A repeated cross-sectional study time series analysis was conducted using NH electronic health records (EHRs) from January 1, 2020, to December 31, 2021.
Setting and participants: A large, multistate sample of NH residents living with ADRD.
Methods: We calculated weekly changes in facility-level prevalence of antipsychotic use using interrupted time series (ITS) to compare level and slope changes in antipsychotic use before, during, and after NH visitation restrictions. Generalized linear models with generalized estimating equations, logit link, binomial distribution, and AR-1 correlation structure were used for all ITS analyses. Final models were stratified by long- and short-stay residents and adjusted for NH-level covariates including resident demographics, clinical diagnoses, and nurse staffing.
Results: We observed more than 8500 long-stay and 2700 short-stay NH residents with ADRD. Among long-stay residents, the weekly prevalence of antipsychotic use increased from 18.9% as of January 7, 2020, to 24.9% by December 31, 2021. For short-stay residents, antipsychotic use increased from 21.1% to 26.6% over this same window. The ITS analysis showed no meaningful changes in the relative rate of change in antipsychotic use during and after visitor restrictions, relative to pre-policy trends.
Conclusions and implications: The Centers for Medicare and Medicaid Services visitation restriction policy had no meaningful impact on antipsychotic use among NH residents with ADRD. However, antipsychotic use increased over time for both long- and short-stay residents and remained above pre-pandemic levels by the end of 2021. Our findings emphasize the potential for increased reliance on pharmacotherapy to manage resident symptoms during public health emergencies. Future infection control efforts should prioritize safe interpersonal care delivery and consider policies that improve vigilance of medication utilization changes among high-risk populations.