Psychotropic use for behavioral and psychological symptoms of dementia during the COVID-19 pandemic: a systematic review and meta-analysis
Abstract Background During the COVID-19 pandemic, the provision of quality care for behavioral and psychological symptoms in older adults with dementia may have been impeded due to physical distancing and infection control measures. Of particular concern is whether psychotropic medication use has in...
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BMC
2024-11-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-024-05563-4 |
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| author | Jung Min Yoon Eunjin Kim Alison M. Trinkoff |
| author_facet | Jung Min Yoon Eunjin Kim Alison M. Trinkoff |
| author_sort | Jung Min Yoon |
| collection | DOAJ |
| description | Abstract Background During the COVID-19 pandemic, the provision of quality care for behavioral and psychological symptoms in older adults with dementia may have been impeded due to physical distancing and infection control measures. Of particular concern is whether psychotropic medication use has increased despite its limited efficacy and adverse effects. This systematic review described the trajectory of psychotropic use for older adults with dementia across various settings, from community living to healthcare settings during the pandemic. Also, psychotropic use was explored in relation to patients, caregivers, and environment-related factors along with the occurrence of the pandemic. Methods We conducted a comprehensive search across five databases: Embase, PubMed, PsycINFO, CINAHL, and Cochrane Library. Methodological quality was assessed using Joanna Briggs Institute Critical Appraisal tools. A random-effects model was used to estimate the pooled risk ratios (RRs) of psychotropic use in older adults with dementia, comparing the pandemic period to the pre-pandemic period. Subgroup analyses based on the class of psychotropics and sensitivity analyses also were conducted. A funnel plot and Egger’s regression test were used to detect potential publication bias. Results Of the 3,123 screened articles, 15 studies were included in this systematic review, with 10 of them being part of the meta-analysis. Our meta-analysis yielded an RR of 1.16 (95% CI = 1.05–1.26) for overall psychotropic medication use. Further subgroup analysis based on the type of psychotropic medication revealed a significantly greater prevalence in the use of antipsychotics (RR = 1.19, 95% CI = 1.08–1.30). However, no significant differences were observed in the use of anxiolytics and/or hypnotics (including benzodiazepines), antidepressants, and mood stabilizers. Among psychotropics, some studies on antipsychotic use additionally explored patients, caregivers, and environmental-related factors during the pandemic. Conclusions The review indicates a higher risk of psychotropic use, especially antipsychotics, during the pandemic. Nonetheless, underlying reasons for the increased psychotropic use are not fully available from the reviewed studies. Therefore, further research is needed to identify the factors driving psychotropic use during the pandemic and facilitate the development of quality improvement interventions that can be implemented to minimize inappropriate psychotropic prescribing in future pandemics. |
| format | Article |
| id | doaj-art-8db44c6fbd3a4db296be53ded2009d47 |
| institution | Kabale University |
| issn | 1471-2318 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj-art-8db44c6fbd3a4db296be53ded2009d472024-11-24T12:42:24ZengBMCBMC Geriatrics1471-23182024-11-0124111110.1186/s12877-024-05563-4Psychotropic use for behavioral and psychological symptoms of dementia during the COVID-19 pandemic: a systematic review and meta-analysisJung Min Yoon0Eunjin Kim1Alison M. Trinkoff2College of Nursing, Ewha Womans UniversityCollege of Nursing, Ewha Womans UniversityUniversity of Maryland School of NursingAbstract Background During the COVID-19 pandemic, the provision of quality care for behavioral and psychological symptoms in older adults with dementia may have been impeded due to physical distancing and infection control measures. Of particular concern is whether psychotropic medication use has increased despite its limited efficacy and adverse effects. This systematic review described the trajectory of psychotropic use for older adults with dementia across various settings, from community living to healthcare settings during the pandemic. Also, psychotropic use was explored in relation to patients, caregivers, and environment-related factors along with the occurrence of the pandemic. Methods We conducted a comprehensive search across five databases: Embase, PubMed, PsycINFO, CINAHL, and Cochrane Library. Methodological quality was assessed using Joanna Briggs Institute Critical Appraisal tools. A random-effects model was used to estimate the pooled risk ratios (RRs) of psychotropic use in older adults with dementia, comparing the pandemic period to the pre-pandemic period. Subgroup analyses based on the class of psychotropics and sensitivity analyses also were conducted. A funnel plot and Egger’s regression test were used to detect potential publication bias. Results Of the 3,123 screened articles, 15 studies were included in this systematic review, with 10 of them being part of the meta-analysis. Our meta-analysis yielded an RR of 1.16 (95% CI = 1.05–1.26) for overall psychotropic medication use. Further subgroup analysis based on the type of psychotropic medication revealed a significantly greater prevalence in the use of antipsychotics (RR = 1.19, 95% CI = 1.08–1.30). However, no significant differences were observed in the use of anxiolytics and/or hypnotics (including benzodiazepines), antidepressants, and mood stabilizers. Among psychotropics, some studies on antipsychotic use additionally explored patients, caregivers, and environmental-related factors during the pandemic. Conclusions The review indicates a higher risk of psychotropic use, especially antipsychotics, during the pandemic. Nonetheless, underlying reasons for the increased psychotropic use are not fully available from the reviewed studies. Therefore, further research is needed to identify the factors driving psychotropic use during the pandemic and facilitate the development of quality improvement interventions that can be implemented to minimize inappropriate psychotropic prescribing in future pandemics.https://doi.org/10.1186/s12877-024-05563-4DementiaBehavioral and psychological symptomsPsychotropic medication useCOVID-19 pandemic |
| spellingShingle | Jung Min Yoon Eunjin Kim Alison M. Trinkoff Psychotropic use for behavioral and psychological symptoms of dementia during the COVID-19 pandemic: a systematic review and meta-analysis BMC Geriatrics Dementia Behavioral and psychological symptoms Psychotropic medication use COVID-19 pandemic |
| title | Psychotropic use for behavioral and psychological symptoms of dementia during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_full | Psychotropic use for behavioral and psychological symptoms of dementia during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_fullStr | Psychotropic use for behavioral and psychological symptoms of dementia during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_full_unstemmed | Psychotropic use for behavioral and psychological symptoms of dementia during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_short | Psychotropic use for behavioral and psychological symptoms of dementia during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_sort | psychotropic use for behavioral and psychological symptoms of dementia during the covid 19 pandemic a systematic review and meta analysis |
| topic | Dementia Behavioral and psychological symptoms Psychotropic medication use COVID-19 pandemic |
| url | https://doi.org/10.1186/s12877-024-05563-4 |
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