Aims
Victoria experienced rapidly rising COVID-19 numbers in 2020, which quickly spread into Residential Aged Care Facilities (RACF). Eastern Health in Melbourne developed an innovative model of care for residents with COVID-19 who could not be safely managed in their RACF due to behavioural and psychological symptoms of dementia (BPSD). This study aims to investigate the strategies implemented to manage a cognitively vulnerable cohort with high risk of BPSD, and subsequent prescription of psychotropics.
Methods
This was a single centre, retrospective, observational audit. Chart reviews and individual characteristics were collected for the fifty-one patients admitted to the COVID-19 Supportive Care Unit during the eighty-five days of operation. Ten patients died and were excluded from the final data. Psychotropic medications were reviewed on admission, day seven (thought to be the peak of illness severity) and discharge.
Results
Twenty-four patients were admitted with regular prescriptions of psychotropic medications, with 63% achieving deprescription on discharge (p=0.004). Psychotropic medications were classified as either antipsychotics, benzodiazepines or antidepressants. Eleven patients were admitted with regular prescriptions of antipsychotic medications, with 82% achieving deprescription on discharge (p=0.019). Two patients required code grey responses, and 9.8% patients required injectable psychotropic medications for BPSD management. Adverse effects were not increased as a result.
Conclusions
Effective implementation of non-pharmacological strategies, multi-disciplinary geriatric care and a patient-centred approach allowed the safe deprescription of psychotropics for RACF residents with COVID-19, who were at high risk of worsening BPSD and escalating psychotropic prescriptions. These strategies can help to guide future models of care.