School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada.
Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
J Am Med Dir Assoc. 2024 Jan;25(1):121-129. doi: 10.1016/j.jamda.2023.09.009. Epub 2023 Oct 17.
To examine the associations between COVID-19 pandemic waves (1-4) and prevalent antipsychotic, antidepressant, benzodiazepine, anticonvulsant, and opioid use among assisted living (AL) residents, by setting (dementia care vs other).
Population-based, repeated cross-sectional study.
Linked clinical and health administrative databases for residents of all publicly subsidized AL homes (N = 256) in Alberta, Canada, examined from January 2018 to December 2021. Setting-specific quarterly cohorts of residents were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods.
The quarterly proportion of residents dispensed an antipsychotic, antidepressant, benzodiazepine, anticonvulsant, or opioid was examined for each setting and period. Log-binomial generalized estimating equations models estimated prevalence ratios (PR) for period (pandemic vs historical quarterly periods), setting (dementia care vs other AL), and period-setting interactions.
On March 1, 2020, there were 2874 dementia care and 6611 other AL residents (mean age 82.4 vs 79.9 years, 68.2% vs 66.1% female, 93.5% vs 42.6% with dementia, respectively). Antipsychotic use increased during waves 2 to 4 for residents of both settings, but this increase was significantly greater for dementia care than other AL residents during waves 3 and 4 (eg, wave 3, PR 1.21, 95% CI 1.14-1.27 vs PR 1.12, 95% CI 1.07-1.17, interaction term P = .029). In both settings, there was a significant but modest increase in antidepressant use and a significant decrease in benzodiazepine use during several pandemic waves. For other AL residents only, there was a small statistically significant increase in anticonvulsant use during waves 2 to 4. No significant pandemic effect was observed for prevalent opioid use in either setting.
The persistence of the pandemic-associated increase in antipsychotic, antidepressant, and anticonvulsant use in AL residents, and greater increase in antipsychotic use for dementia care settings, raises concerns about the attendant risks for residents, especially those with dementia.
通过设置（痴呆护理与其他）来研究 COVID-19 大流行波（1-4）与辅助生活（AL）居民中普遍使用的抗精神病药、抗抑郁药、苯二氮䓬类、抗惊厥药和阿片类药物之间的关联。
基于人群的重复横断面研究。
对加拿大艾伯塔省所有公共补贴的辅助生活住宅（N=256）的居民进行了临床和健康行政数据库的链接，研究时间为 2018 年 1 月至 2021 年 12 月。根据大流行（从 2020 年 3 月 1 日开始）和可比历史（2018/2019 年合并）时期，为每个设置衍生了特定季度的居民队列。
检查了每个设置和时期中接受抗精神病药、抗抑郁药、苯二氮䓬类、抗惊厥药或阿片类药物的居民的季度比例。使用对数二项式广义估计方程模型估计了时期（大流行与历史季度时期）、设置（痴呆护理与其他 AL）和时期-设置相互作用的患病率比（PR）。
2020 年 3 月 1 日，痴呆护理有 2874 名居民和 6611 名其他 AL 居民（平均年龄 82.4 岁 vs 79.9 岁，68.2% vs 66.1%女性，93.5% vs 42.6%有痴呆症）。在两个设置中，抗精神病药的使用在波 2 到 4 期间都有所增加，但在波 3 和 4 期间，痴呆护理的增加幅度明显大于其他 AL 居民（例如，波 3，PR 1.21，95%CI 1.14-1.27 vs PR 1.12，95%CI 1.07-1.17，交互项 P=0.029）。在两个设置中，抗抑郁药的使用都有显著但适度的增加，苯二氮䓬类的使用则有显著减少。对于其他 AL 居民，仅在波 2 到 4 期间，抗惊厥药的使用有较小的统计学意义上的增加。在任何一个设置中，都没有观察到阿片类药物使用与大流行相关的显著增加。
辅助生活居民中与大流行相关的抗精神病药、抗抑郁药和抗惊厥药使用的持续增加，以及痴呆护理设置中抗精神病药使用的增加幅度更大，令人担忧居民，尤其是那些患有痴呆症的居民的潜在风险。
