Trends in psychotropic use among older adults with dementia in Korean long-term care hospitals across the COVID-19 pandemic: a national longitudinal study.

BACKGROUND

Disruptions to routine care and non-pharmacological interventions during the COVID-19 pandemic placed significant stress on dementia care in South Korea's long-term care (LTC) hospitals, which operate under a medicalized, insurance-integrated structure with high reliance on pharmacologic symptom management. However, limited research has examined whether psychotropic use increased in Korean LTC hospitals during the pandemic and whether changes persisted after the early pandemic period among older adults with dementia.

METHODS

A national longitudinal study was conducted using Korean National Health Insurance Service claims data for 385,602 older adults (≥ 65 years) with dementia hospitalized in LTC hospitals from 2019, Quarter 4 to 2021, Quarter 4. Quarterly psychotropic use was assessed using prescription days and defined daily doses (DDDs), each standardized per 100 inpatient-days. Linear mixed models with LTC-hospital random intercepts were used to estimate quarterly trends, adjusting for facility and patient-level factors.

RESULTS

Compared with the 2019Q4 baseline, adjusted prescription days and DDDs increased for all psychotropic classes (all p < 0.0001). Antipsychotic medications showed the largest increases, peaking in 2021Q1 [2.67 days (95% CI 2.26-3.12) and 0.57 DDDs (95% CI 0.48-0.68)] and remaining above baseline in 2021Q4 [0.27 days (95% CI 0.06-0.50) and 0.09 DDDs (95% CI 0.03-0.16)], although diminishing in the later quarters. Anxiolytics and antidepressants also increased, with larger early-pandemic rises for anxiolytics [e.g., 2020Q1: 0.17 days (95% CI 0.12-0.22) and 0.10 DDDs (95% CI 0.07-0.14)] and steady increases for antidepressants through 2021Q4 [0.14 days (95% CI 0.10-0.19) and 0.09 DDDs (95% CI 0.07-0.12)].

CONCLUSION

Psychotropic use remained elevated above pre-pandemic baseline levels through 2021, although increases attenuated substantially in the later quarters, particularly for antipsychotics. These findings suggest increased reliance on pharmacologic symptom management when routine psychosocial dementia care was constrained. Strengthening crisis-resilient, person-centered dementia care in LTC hospitals, including continuity of non-pharmacological interventions, staffing supports, and psychotropic stewardship and monitoring beyond antipsychotics, may reduce psychotropic reliance during public health emergencies.