Benzodiazepine and antipsychotic use among hospitalized older adults before versus after restricting visitation: March to May 2020.

BACKGROUND: Hospital visitation restrictions during the COVID-19 pandemic prompted concerns about unintended consequences for older patients, including an increased incidence of delirium and agitation. While first-line interventions for these conditions are non-pharmacologic, a lack of family support could result in increased use of benzodiazepines and antipsychotics, which are associated with poor outcomes in older adults. Little is known about the association of visitation policies with use of these medications among older adults. METHODS: We conducted a retrospective cross-sectional study among adults aged ≥65 hospitalized from March 1 through May 31, 2020 at four hospitals in the Mid-Atlantic. The dates of onset of visitation restrictions (i.e., hospital-wide guidelines barring visitors) were collected from hospital administrators. Outcomes were use of benzodiazepines and antipsychotics, assessed using patient-level electronic health record data. Using multivariable logistic regression with hospital and study-day fixed effects, the quasi-experimental study design leveraged the staggered onset of visitation restrictions across the hospitals to measure the odds of receiving each medication when visitors were versus were not allowed. RESULTS: Among 2931 patients, mean age was 76.6 years (SD, 8.3), 51.6% were female, 58.6% white, 32.5% black, and 2.6% Hispanic. Overall, 924 (31.5%) patients received a benzodiazepine and 298 (10.2%) an antipsychotic. The adjusted odds of benzodiazepine use was lower on days when visitors were versus were not allowed (adjusted odds ratio [AOR], 0.62; 95% CI, 0.39, 0.99). Antipsychotic use did not significantly differ between days when visitors were versus were not allowed (AOR, 0.98; 95% CI, 0.43, 2.21). CONCLUSIONS: Among older patients hospitalized during the first wave of the pandemic, benzodiazepine use was lower on days when visitors were allowed. These findings suggest that the presence of caregivers impacts use of potentially inappropriate medications among hospitalized older adults, supporting efforts to recognize caregivers as essential members of the care team.

Preliminary results from the COVID caregiving project

Background In the United States, family caregivers are the cornerstone of the support system for persons living with dementia (PLWD). This study examined how the coronavirus disease 2019 (COVID-19) pandemic challenged caregivers? capacity to deliver long term care services and supports to PLWD. Method Participants (expected N=40) in this qualitative study are family caregivers for PLWD who reside in either the community or a long-term care facility. Family caregivers participate in semi-structured, hour-long telephonic interviews covering: (1) adequacy of caregiving supports;(2) social, emotional, physical, financial, and other effects of caregiving during the COVID-19 pandemic on the caregiver;and (3) effects of the COVID-19 pandemic on the person with dementia. Interviews are audio-recorded, transcribed, and coded in NVivo. The University of Pennsylvania IRB approved this study. Results Preliminary results show that social distancing measures disrupted services and supports for PLWD (e.g., closure of adult day centers). Efforts to minimize the risk of COVID-19 disease or death for the person with dementia increased caregiver work and feelings of burden. Many caregivers described making difficult tradeoffs. Some reduced their utilization of supports (e.g., forgoing having paid aides come into the home, limiting visits from other family members), but this has increased workload and limited opportunities for respite. Other caregivers reduced work hours or left the workforce entirely (e.g., because they deemed their risk of SARS-CoV-2 exposure on the job too high), but this has increased financial vulnerability and social isolation. A majority of caregivers expressed concern that social distancing has negatively affected the person in their care;many perceive a hastening of cognitive decline and feel their time with the person with dementia has been limited by the pandemic. Caregivers for long-term care facility residents reported frustration with limited visitation opportunities as well as a perceived decrease in quality of care and lack of transparency. Conclusion Our results will help characterize the impact of the COVID-19 pandemic on PLWD and their caregivers. They will inform ethical guidelines and policies to improve the delivery of services and supports for PLWD and the ability of people to perform the work of caregiving.