The Impact of Disasters on Mental Health Medication for People with Dementia

Introduction: Climate change is associated with increasing frequency and severity of extreme weather events, but little is known about the impact of disaster exposure on people living with dementia (PLWD). PLWD may experience increased confusion, disorientation, anxiety, and paranoia during disasters, potentially leading to the inappropriate use of psychotropic medications as a form of symptom management. This study examined new psychotropic prescription medications or changes to existing prescriptions among US Medicare beneficiaries with a dementia diagnosis following hurricane exposure. Methods: This study used a retrospective cohort design with administrative claims data from Medicare beneficiaries diagnosed with dementia. The study population included 71,401 beneficiaries residing in counties exposed to Hurricanes Harvey, Irma, or Florence between 2017 and 2018. Exposure to major hurricanes (Harvey, Irma, and Florence) was determined based on Federal Emergency Management Agency disaster declarations for affected counties. The primary outcome was the rate of new psychotropic prescriptions or changes to existing prescriptions within 12 months post-hurricane exposure, compared between beneficiaries in exposed versus unexposed counties. Results: PLWD exposed to hurricanes had a 10% higher rate of starting new antipsychotic prescriptions compared to those in unexposed counties (Incidence Rate Ratio [IRR]: 1.10; 95% CI, 1.04-1.17). Exposure to Hurricane Harvey was associated with a 20% higher rate of new antipsychotic prescriptions (IRR: 1.20; 95% CI, 1.07-1.36), while no significant changes were observed following Hurricanes Irma (IRR: 0.99; 95% CI, 0.90-1.08) or Florence (IRR: 0.92; 95% CI, 0.80-1.05). Conclusion: Exposure to Hurricane Harvey was associated with increased rates of new antipsychotic prescriptions among PLWD, suggesting that tailored disaster preparedness and response strategies are needed to address the unique needs of this vulnerable population. Understanding patterns in psychotropic medication prescribing among PLWD before, during, and after disasters is essential to improving disaster readiness and reducing inappropriate medication use.