Association between the coronavirus disease pandemic and antipsychotic drug prescriptions among patients with dementia

Abstract

Background Antipsychotics are frequently prescribed off-label to manage behavioral and psychological symptoms of dementia but pose safety risks in older adults, including a 1.5-2.0-fold increased risk of mortality. The coronavirus disease (COVID-19) pandemic disrupted dementia care, increasing reliance on pharmacologic treatments. Objective This study aimed to evaluate whether the COVID-19 pandemic was associated with changes in the prevalence of antipsychotic prescribing among patients with dementia. Methods Using the Korean National Health Insurance Database, this study analyzed a random 50% sample of eligible individuals aged >= 60 years diagnosed with dementia between 2016 and 2021 (n = 876,158; 9.8 million person-observations). Outcomes included the likelihood, duration, and number of antipsychotic prescriptions issued, characterizing pharmacologic management of dementia. Interrupted time series analysis assessed associations between the pandemic and relative changes in these outcomes, adjusting for demographic factors, comorbid burden, and seasonality. Results After the pandemic onset, there were relative slope increases per quarter of 1.5%, 3.2%, and 0.4% in the likelihood, duration, and number of prescriptions, respectively (all p < 0.001; pre-pandemic levels: 0.172 patients prescribed, 12.97 days, and 18.10 prescriptions per person-quarter). Antipsychotic prescriptions decreased by 1.6% (p < 0.001) during the first quarter after the outbreak but subsequently showed a progressive increase, reflecting prolonged care disruption after initial access barriers. Conclusions The COVID-19 pandemic was associated with increased antipsychotic prescribing among patients with dementia. To mitigate similar effects in future public health crises, governments and healthcare providers should strengthen mental health support, non-pharmacological interventions, telehealth continuity, and tailored prescribing guidelines.