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Impact of the Covid-19 pandemic on neuropsychiatric symptoms and antipsychotic prescribing for people with dementia in nursing home settings

McDermid, Joanne; Ballard, Clive; Khan, Zunera; Aarsland, Dag; Fox, Chris; Fossey, Jane; Clare, Linda; Moniz-Cook, Esme; Soto-Martin, Maria; Sweetnam, Adrienne; Mills, Kathryn; Cummings, Jeffrey; Corbett, Anne


Joanne McDermid

Clive Ballard

Zunera Khan

Dag Aarsland

Chris Fox

Jane Fossey

Linda Clare

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Professor Esme Moniz-Cook
Professor of Clinical Psychology of Ageing and Dementia Care Research/ Dementia Research Work Group Lead

Maria Soto-Martin

Adrienne Sweetnam

Kathryn Mills

Jeffrey Cummings

Anne Corbett


Objectives: This study aimed to determine the impact of the Covid-19 pandemic on neuropsychiatric symptoms and antipsychotic use in people with dementia living in nursing homes. Methods: This was a comparative analysis of baseline data from two large nursing home studies, one conducted during (COVID-iWHELD study) and one prior (WHELD study) to the pandemic. It involves data from 69 and 149 nursing homes, and 1006 and 666 participants respectively. Participants were people with established dementia (score >1 on Clinical Dementia Rating Scale). Resident data included demographics, antipsychotic prescriptions and neuropsychiatric symptoms using the Neuropsychiatric Inventory Nursing Home version. Nursing home data collected were nursing home size and staffing information. Results: Overall prevalence of neuropsychiatric symptoms was unchanged from pre-pandemic prevalence. Mean antipsychotic use across the sample was 32.0%, increased from 18% pre-pandemic (Fisher's exact test p < 0.0001). At a nursing home level, the medians for the low, medium and high tertiles for antipsychotic use were 7%, 20% and 59% respectively, showing a disproportionate rise in tertile three. Residents in these homes also showed a small but significant increase in agitation. Conclusion: There has been a significant increase in antipsychotic prescribing in nursing homes since the COVID-19 pandemic, with a disproportionate rise in one third of homes, where median prescription rates for antipsychotics were almost 60%. Strategies are urgently needed to identify these nursing homes and introduce pro-active support to bring antipsychotic prescription rates back to pre-pandemic levels.


McDermid, J., Ballard, C., Khan, Z., Aarsland, D., Fox, C., Fossey, J., …Corbett, A. (2023). Impact of the Covid-19 pandemic on neuropsychiatric symptoms and antipsychotic prescribing for people with dementia in nursing home settings. International journal of geriatric psychiatry, 38(1), Article e5878.

Journal Article Type Article
Acceptance Date Jan 9, 2023
Online Publication Date Jan 16, 2023
Publication Date 2023-01
Deposit Date Feb 11, 2023
Journal International Journal of Geriatric Psychiatry
Print ISSN 0885-6230
Electronic ISSN 1099-1166
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 38
Issue 1
Article Number e5878
Keywords Antipsychotics; Covid; Dementia; Neuropsychiatric; Nursing home
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