A quantitative and qualitative analysis of medicines use by care home residents with dementia during the COVID-19 pandemic

Abstract

The COVID-19 pandemic disproportionately affected residents with dementia, and may have exacerbated existing medication challenges for them, due to restrictions on visiting, staff absences, and an increased prevalence of non-cognitive symptoms. The aim of this thesis was to examine medicines use by care home residents with dementia during the COVID-19 pandemic. Care home managers’ experiences of optimising medicines for residents with dementia were explored through semi-structured interviews (n=14), followed by cross-sectional, questionnaires (n=215). A documentary analysis of medicines management inspection reports (n=278) was conducted to assess the extent to which care homes met the arrangements and measures of medicines management. A retrospective observational study was conducted using the Enhanced Prescribing Database and other data sources to investigate the prevalence and patterns of dispensing of psychotropic medications, over a five-year period (2018 – 2022) among residents with dementia (n=7,544). Care home managers described an overwhelming sense of isolation for them and their residents during the pandemic with increased burden on their staff and residents. Medication reviews were disrupted and issues with communication were reported. Survey data highlighted the dissatisfaction that care home managers felt when accessing health services, lack of medication review and face-to-face contact with healthcare professionals, and changes in modes of communication and consultation. Inspection reports highlighted that robust arrangements were not in place in some care homes with respect to prescribing, administration, monitoring and review of medicines. Changes in dispensing of some classes of psychotropic medications among residents with dementia were observed during the pandemic: dispensing of antipsychotic medications increased, particularly in males and those aged ≥85 years, whilst dispensing of antidepressant medications decreased. The research presented in this thesis has provided an understanding of the short-term effects of the COVID-19 pandemic on medicines optimisation for residents with dementia, and adds to the growing evidence base in this area.