PDF(Pubmed)
Abstract：
BACKGROUND: Assisted living (AL) is an increasingly common residential setting for persons with dementia; yet concerns exist about sub-optimal care of this population in AL given its lower levels of staffing and services. Our objectives were to (i) examine associations between AL setting (dementia care vs. other), COVID-19 pandemic waves, and prevalent antipsychotic, antidepressant, anti-dementia, benzodiazepine, and anticonvulsant drug use among residents with dementia/cognitive impairment, and (ii) explore associations between resident and home characteristics and prevalent medication use.
METHODS: We conducted a population-based, repeated cross-sectional study using linked clinical and health administrative databases for all publicly funded AL homes in Alberta, Canada, examined between January 2018 - December 2021. The quarterly proportion of residents dispensed a study medication was examined for each setting and period (pandemic vs. comparable historical [2018/2019 combined]) focusing on four pandemic waves (March-May 2020, September 2020-February 2021, March-May 2021, September-December 2021). Log-binomial GEE models estimated prevalence ratios (PR) for period (pandemic vs. historical periods), setting (dementia care vs. other) and period-setting interactions, adjusting for resident (age, sex) and home (COVID-19 cases, health region, ownership) characteristics.
RESULTS: On March 1, 2020, there were 2,779 dementia care and 3,013 other AL residents (mean age 83, 69% female) with dementia/cognitive impairment. Antipsychotic use increased during waves 2-4 in both settings, but this was more pronounced in dementia care than other AL during waves 3 and 4 (e.g., adjusted [adj]PR 1.20, 95% CI 1.14-1.27 vs. adjPR 1.09, 95% CI 1.02-1.17, interaction p = 0.023, wave 3). Both settings showed a statistically significant but modest increase in antidepressant use and decrease in benzodiazepine use. For dementia care AL residents only, there was a statistically significant increase in gabapentinoid use during several waves (e.g., adjPR 1.32, 95% CI 1.10-1.59, wave 3). Other than a modest decrease in prevalent anti-dementia drug use for both settings in wave 2, no other significant pandemic effects were observed.
CONCLUSIONS: The persistence of the pandemic-associated increase in antipsychotic and antidepressant use in AL residents coupled with a greater increase in antipsychotic and gabapentinoid use for dementia care settings raises concerns about the attendant risks for residents with cognitive impairment.
METHODS: We conducted a population-based, repeated cross-sectional study using linked clinical and health administrative databases for all publicly funded AL homes in Alberta, Canada, examined between January 2018 - December 2021. The quarterly proportion of residents dispensed a study medication was examined for each setting and period (pandemic vs. comparable historical [2018/2019 combined]) focusing on four pandemic waves (March-May 2020, September 2020-February 2021, March-May 2021, September-December 2021). Log-binomial GEE models estimated prevalence ratios (PR) for period (pandemic vs. historical periods), setting (dementia care vs. other) and period-setting interactions, adjusting for resident (age, sex) and home (COVID-19 cases, health region, ownership) characteristics.
RESULTS: On March 1, 2020, there were 2,779 dementia care and 3,013 other AL residents (mean age 83, 69% female) with dementia/cognitive impairment. Antipsychotic use increased during waves 2-4 in both settings, but this was more pronounced in dementia care than other AL during waves 3 and 4 (e.g., adjusted [adj]PR 1.20, 95% CI 1.14-1.27 vs. adjPR 1.09, 95% CI 1.02-1.17, interaction p = 0.023, wave 3). Both settings showed a statistically significant but modest increase in antidepressant use and decrease in benzodiazepine use. For dementia care AL residents only, there was a statistically significant increase in gabapentinoid use during several waves (e.g., adjPR 1.32, 95% CI 1.10-1.59, wave 3). Other than a modest decrease in prevalent anti-dementia drug use for both settings in wave 2, no other significant pandemic effects were observed.
CONCLUSIONS: The persistence of the pandemic-associated increase in antipsychotic and antidepressant use in AL residents coupled with a greater increase in antipsychotic and gabapentinoid use for dementia care settings raises concerns about the attendant risks for residents with cognitive impairment.
摘要：
背景：辅助生活（AL）是痴呆症患者越来越普遍的居住环境；然而，由于AL的人员配备和服务水平较低，人们对该人群的次优护理存在担忧。我们的目标是(I)检查AL设置(痴呆症护理与其他),COVID-19大流行浪潮，和流行的抗精神病药，抗抑郁药,抗痴呆,苯二氮卓,和抗惊厥药物的使用在居民痴呆/认知障碍，（ii）探索居民和家庭特征与普遍药物使用之间的关联。
方法：我们以人群为基础，使用关联的临床和健康管理数据库对艾伯塔省所有公共资助的AL家庭进行重复的横断面研究，加拿大,在2018年1月至2021年12月之间进行了检查。在每个环境和时期检查了分配研究药物的居民的季度比例(大流行与可比历史[2018/2019年合并]）关注四个大流行浪潮（2020年3月-5月、2020年9月-2021年2月、2021年3月-5月、2021年9月-12月）。对数二项GEE模型估计的期间患病率比率(PR)(大流行与历史时期)，设置(痴呆症护理与其他)和周期设定互动，调整为居民(年龄，性别）和家庭（COVID-19病例，卫生区域,所有权)特征。
结果：2020年3月1日，有2,779名痴呆症患者和3,013名其他AL居民（平均年龄83岁，女性占69％）患有痴呆症/认知障碍。在两种情况下，抗精神病药的使用在第2-4波中增加，但在第3波和第4波期间，这在痴呆症护理中比其他AL更明显(例如，调整后的[调整]PR1.20，95%CI1.14-1.27与adjPR1.09，95%CI1.02-1.17，相互作用p=0.023，波3）。两种设置均显示出具有统计学意义但适度的抗抑郁药使用增加和苯二氮卓类药物使用减少。仅适用于痴呆症护理AL居民，在几波期间，加巴喷丁的使用在统计学上显着增加(例如，adjPR1.32，95%CI1.10-1.59，第3波）。在第2波中，除了两种情况下流行的抗痴呆药物的使用略有减少外，没有观察到其他明显的大流行效应。
结论：大流行相关的抗精神病药和抗抑郁药在AL居民中的使用持续增加，再加上抗精神病药和加巴喷丁类药物在痴呆症护理环境中的使用增加，引起了对认知障碍居民随之而来的风险的担忧。
方法：我们以人群为基础，使用关联的临床和健康管理数据库对艾伯塔省所有公共资助的AL家庭进行重复的横断面研究，加拿大,在2018年1月至2021年12月之间进行了检查。在每个环境和时期检查了分配研究药物的居民的季度比例(大流行与可比历史[2018/2019年合并]）关注四个大流行浪潮（2020年3月-5月、2020年9月-2021年2月、2021年3月-5月、2021年9月-12月）。对数二项GEE模型估计的期间患病率比率(PR)(大流行与历史时期)，设置(痴呆症护理与其他)和周期设定互动，调整为居民(年龄，性别）和家庭（COVID-19病例，卫生区域,所有权)特征。
结果：2020年3月1日，有2,779名痴呆症患者和3,013名其他AL居民（平均年龄83岁，女性占69％）患有痴呆症/认知障碍。在两种情况下，抗精神病药的使用在第2-4波中增加，但在第3波和第4波期间，这在痴呆症护理中比其他AL更明显(例如，调整后的[调整]PR1.20，95%CI1.14-1.27与adjPR1.09，95%CI1.02-1.17，相互作用p=0.023，波3）。两种设置均显示出具有统计学意义但适度的抗抑郁药使用增加和苯二氮卓类药物使用减少。仅适用于痴呆症护理AL居民，在几波期间，加巴喷丁的使用在统计学上显着增加(例如，adjPR1.32，95%CI1.10-1.59，第3波）。在第2波中，除了两种情况下流行的抗痴呆药物的使用略有减少外，没有观察到其他明显的大流行效应。
结论：大流行相关的抗精神病药和抗抑郁药在AL居民中的使用持续增加，再加上抗精神病药和加巴喷丁类药物在痴呆症护理环境中的使用增加，引起了对认知障碍居民随之而来的风险的担忧。
