Patterns of Daily Administration of Psychoactive Drug Classes for Distress Behavior in Dementia

Objectives Distress behaviors in dementia (DBDs) are common, are a significant burden to patients, families, and caregivers, and decrease quality of life. Despite risks, many nursing home (NH) residents are prescribed ≥ 1 classes of psychoactive medications for DBD. The objective of this study was to examine daily use of 4 classes of psychoactive medication in NH residents with DBD. Design This was a retrospective longitudinal cohort study. Setting and Participants Participants included long-stay Veterans Affairs NH residents with dementia in 2019-2020, with and without DBD. Methods We identified daily use of antipsychotics, benzodiazepines, antidepressants, and antiepileptics, identified from bar-coded administration data, from 30 days prior to 30 days after a documented DBD incident. We estimated multivariate associations between resident characteristics and administration of selected classes of medication on the DBD incident day, accounting for prior class use. Results The DBD and comparison groups consisted of 974 and 1138 individuals, respectively. Overall, the groups were 76 years old on average, and 14% had severe cognitive impairment. Administration of antipsychotic and benzodiazepine medication rose slightly 3 to 7 days before the DBD incident day, followed by sharp rises in administration on the DBD incident day, and sharp declines the next day. Increases in both classes persisted 30 days after the DBD incident day. None of these changes were observed in the comparison group. There were associations between benzodiazepine and antipsychotic administration and mental health conditions, and an inverse association between benzodiazepine administration and recent past gabapentin receipt. Conclusions and Implications Patterns of psychoactive medication administration varied among drug classes, but were linked across drug classes. Efforts to reduce prescribing of these medications need to be designed to take into account multiple classes of medication and target early signs of distress behavior.