The use of psychotropic medications in residential aged care could be a contributing factor to the poor outcomes of residents who contract COVID-19, but more research is needed, say leading experts in the field.
Steven Macfarlane, head of clinical services at HammondCare’s Dementia Centre, told HelloCare that residents who are taking psychotropic medications could experience worse outcomes if they contract COVID-19.
“Many of the psychotropics that are used in residential care are sedating,” Dr Macfarlane explained.
“The benzodiazepines, especially, suppress respiratory function, so it makes sense if you have a primarily respiratory disease (such as COVID-19) and you’re taking medication that further depresses your ability to breathe, that’s going to worsen the outcome of someone affected with COVID-19 in residential care, or anywhere,” he said.
Dr Macfarlane’s comments echo those of his colleague, Colm Cunningham, director of The Dementia Centre, who wrote recently about support for people living with dementia during the pandemic.
“The use of medications that might cause respiratory depression or render a person immobile is likely to lead to an adverse outcome for that resident,” he wrote.
More research is needed
Juanita Breen, senior lecturer in dementia studies at the Wicking Dementia Research and Education Centre at the University of Tasmania, told HelloCare that people taking antipsychotics or benzodiazepines have higher rates of pneumonia, and it “wouldn’t be surprising” to her if taking these medications were also a contributing factor to increased risk from other types of infections, such as viral infections, but more research is needed.
Dr Breen explained that people taking antipsychotics or benzodiazepines are usually in bed and sleeping a lot. They are not up and about as often, and so secretions can collect in the lungs. “It’s an ideal medium for bacteria or viruses,” she said.
“Another theory is that people on these medications often get oedema, they retain fluid and it increases the load for the heart and the lungs.”
Dr Breen said although there is no research linking the use of antipsychotics and diazepines to viral infections, because of the known link with increased risk of pneumonia and urinary tract infections, “it wouldn’t be surprising” to her if there may be a link.
“To draw a direct link between the two of them you would need epidemiological research,” Dr Breen said.
COVID-19 presents new challenges for dementia carers
Dr Breen, who has worked with 150 aged care facilities around Australia, said COVID-19 is presenting new challenges to aged care providers who are caring for an estimated 70 per cent of residents who are living with dementia.
In some facilities, reduced levels of contact and fewer opportunities for diversional therapy are causing an increase in challenging behaviours, she said, but in other facilities staff numbers have increased and residents are receiving more one-to-one-attention so residents’ needs are being met more satisfactorily than usual.
Wearing personal protective equipment (PPE) can also add complications to care, Dr Breen said.
Dr Macfarlane said residents living with dementia at this time may well be experiencing more “behavioural disturbances” as they are more likely to be deprived of visits from family or friends, or staff may appear “strange and foreign” when they approach wearing PPE.
Regardless of the circumstances, Dr Breen said using chemical restraint in aged care to address challenging behaviours should always be used as a last resort.
Dr Macfarlane said the pandemic should not be used as a reason to depart from normal standards of good clinical practice around managing problem behaviours.
“Every published guideline recommends that psycho-social interventions should be used first and psychotropics as a last resort.
“That’s universal and remains current even during the current pandemic, while recognising the additional pressures providers are under at this time,” he said.
Data on COVID and psychotropic medication needed
Dr Breen said she hopes there will be research into the effects of the use of antipsychotics and benzodiazepines on residents with COVID-19, especially in countries where there have been a lot of deaths in aged care facilities.
“That would be a very interesting research project, to look at the people who have passed because of this virus and see what medication they were taking and if there was a higher number taking sedating medications,” she said.
Professor Joseph Ibrahim, Professor and Head of the Health Law and Ageing Research Unit at the Department of Forensic Medicine, Monash University, said more research is needed into any link between use of psychotropic medication and COVID-19.
To understand the issue, he said data would need to be collected on who is taking the medication, when they began taking it, who contracted COVID-19, and whether or not they survived.
Dr Macfarlane said we won’t understand the link between COVID-19 and the use of antipsychotics until aged care providers are more transparent with their data about how often they are using the medications.
“The known association between receiving antipsychotics… and adverse outcomes should be reason itself for providers to make that data available,” he told HelloCare.
Professor Ibrahim agreed there should be greater transparency about the use of psychotropic medication in residential aged care. “Always,” he said, “and not just because of COVID.”