Researchers comparing recent prescribing trends of antipsychotics and pain medications in assisted living communities and nursing homes said they were reassured by relatively stable patterns despite pandemic challenges.

In a study accepted for publication by the Journal of the American Geriatrics Society, the investigators focused on the prescribing of select psychotropic and pain medications to compare medication use before and after March 2020. Specifically, researchers focused on antipsychotics, benzodiazepines, antidepressants, opioids, muscle relaxants and mood stabilizers.

Reducing off-label use of antipsychotic medication in assisted living communities has been a goal of the industry. A new assisted living community accreditation program launched last year by The Joint Commission is using medication management — specifically off-label antipsychotic drug use — as one of its performance measures. The National Center for Assisted Living’s Quality Initiative also looks at antipsychotic medication use. Recent years’ criteria for award recipients have included the use of off-label antipsychotic medications in 15% of residents or less.

Findings reassuring

The investigators did not separate findings by setting. Overall, they found that the use of antipsychotics and pain medications in assisted living and nursing home residents was relatively unchanged between the study period — January 2019 to August 2020. Similar findings emerged over the use of those medications in people who had not used them during the previous month.

“Given the clinical and organizational challenges posed by the pandemic, these findings are reassuring,” the researchers wrote.

But there were distinct trends among residents who were newly admitted, with increased prescribing at the start of the pandemic in some medication classes. 

Some prescriptions rise for new residents

The use of antipsychotics and benzodiazepines among newly admitted residents who had not used those medications previously increased almost 30% from April to August 2020, according to the study. The use of short-acting opioids followed a similar pattern. 

Trends for other medication classes were less clear, the researchers said. Initial prescribing of long-acting opioids and muscle relaxants was relatively stable. Use of mood stabilizers and antidepressants among new admissions varied in pre-COVID months, showed a slight dip in the first part of 2020, and increased between April and August 2020.

The investigators admitted the difficulty in determining the cause of medication use, indicating that staffing challenges, a focus on infection control and a change in resident population during the pandemic could explain a higher reliance on medications. 

They also could not show facility-level trends.

Future research, they said, should incorporate clinical and functional assessment data, as well as the role of facility and geographic factors, in examining trends in more detail.

The study was a collaboration of Vanderbilt University School of Medicine and the VA Tennessee Valley Healthcare System in Nashville; Harvard Medical School in Boston; McLean Hospital in Belmont, MA; and the University of Maryland School of Pharmacy in Baltimore.