Health outcomes in aged care residents with dementia during the COVID-19 pandemic

In response to the COVID-19 pandemic, temporary changes to prescribing and dispensing of PBS medicines were implemented. These changes were aimed at minimising the risk of prescribing doctors, dispensing pharmacists and consumers contracting COVID-19 while ensuring efficient supply of medicines and continued access to medications for consumers. For more information on these changes across the Australian population, see Impact on PBS service utilisation (AIHW 2022).

It should also be noted that on 1 July 2021, following the Royal Commission into Aged Care Quality and Safety (2021), amendments to the Aged Care Act 1997 and Quality of Care Principles 2014 came into effect. These were designed to regulate and strengthen restrictive practices arrangements for Australian Government-funded (approved) residential aged care providers, including the use of psychotropic medications as chemical restraints (Department of Health, Disability and Ageing 2025; Raban et al. 2025).

This report examined the dispensing patterns of medications that are particularly relevant to people living with dementia, including:

• dementia-specific medications (see Dementia-specific medications)
• other psychotropic medications
  • antipsychotics (see Dispensing of antipsychotics to people with dementia)
  • antidepressants
  • benzodiazepines
  • opioids.
    
    

Psychotropic medication dispensing by dementia status

Dementia-specific medications

While there is currently no known cure for dementia, there are 4 medications available through the PBS (3 cholinesterase inhibitors and memantine) that may assist in managing dementia symptoms and slow dementia progression. In Australia, these medications are currently only subsidised for people with a diagnosis of Alzheimer’s disease (see Dementia-specific medications).

At the start of the pandemic, the percentage of aged care residents dispensed at least one dementia-specific medication script decreased from 9.3% in the December 2019 quarter to 8.8% in the June 2020 quarter (Figure 1.5, ‘Percentage’). The percentage then increased gradually to 9.4% by the June 2022 quarter.

The average number of dementia-specific medication scripts dispensed per resident remained steady at 3.1 per quarter (Figure 1.5, ‘Number’).

Antipsychotic medications

Medical professionals may prescribe antipsychotic medicines to people with behavioural and psychological symptoms of dementia (BPSD) as a last resort if non-pharmacological approaches are not successful (ACSQHC 2025). Regulatory changes have been introduced to try to address inappropriate prescribing of antipsychotics (Royal Commission 2021; Raban et al. 2025). However, older adults were at high risk of worsening psychiatric symptoms and severe behavioural disturbances as a result of social isolation during the COVID-19 pandemic (Manca et al. 2020; Numbers et al. 2021) and there were concerns about increased antipsychotic prescribing (Yoon et al. 2024).

Between the March 2019 and March 2020 quarters, the percentage of aged care residents with a dementia record who were dispensed at least one script for antipsychotics had decreased from 23% to 19% (Figure 1.5, ‘Percentage’). 

In 2020, this trend plateaued, with a slight increase from 19% to 20% between the March and September 2020 quarters, followed by a gradual decrease to 18% by the December 2022 quarter.

These findings align with other Australian and international studies (Yoon et al. 2024; Raban et al. 2025), but more detailed analyses would be required to understand the underlying causes. In Australia, a number of factors in early 2020 could have had an impact on antipsychotic prescribing, including regulatory changes in the prescribing of risperidone to people living with dementia (Department of Health, Disability and Ageing 2019), and a range of public health measures applied to facilities and residents aimed at reducing the spread of COVID-19 (Department of Health, Disability and Ageing 2022).

The percentage of residents with no dementia record who were dispensed an antipsychotic was lower overall (about 10%) and remained comparatively steady over the same period. 

The average number of antipsychotic scripts dispensed per resident with a dementia record remained steady at around 2.7 per June quarter (Figure 1.5, ‘Number’), but decreased from 3.7 to 3.3 per quarter between the June 2019 and June 2022 quarters for residents with no dementia record.

Antidepressant medications

Antidepressants are used to treat symptoms of depression and anxiety, and some are used to manage other mental health conditions.

Between 2019 and 2022, the percentage of aged care residents dispensed at least one script for antidepressants remained steady at about 46% of residents with a dementia record and 43% of residents with no dementia record (Figure 1.5, ‘Percentage’). For both groups, there was a decrease in the March 2020 quarter. 

The average number of antidepressant scripts dispensed per resident remained steady at 3.4 per quarter for residents with a dementia record and 3.5 per quarter for residents with no dementia record (Figure 1.5, ‘Number’).

Benzodiazepine medications

Benzodiazepines are used to manage the symptoms of certain mental health conditions, such as anxiety disorders, and to treat insomnia, seizures or muscle spasms.

Between the March 2019 and December 2022 quarters, the percentage of aged care residents dispensed at least one script for benzodiazepines decreased steadily:

• from 19% to 11% of residents with a dementia record
• from 22% to 16% of residents with no dementia record (Figure 1.5, ‘Percentage’).

The average number of benzodiazepine scripts dispensed per resident remained steady at 2.9 per quarter for residents with a dementia record and 3.1 per quarter for residents with no dementia record (Figure 1.5, ‘Number’).

Opioid medications

Opioids are used to relieve pain and relax muscles; some may be used in palliative care.

The percentage of aged care residents dispensed at least one script for opioids increased slightly between the December 2019 and June 2020 quarters:

• from 31% to 33% of residents with a dementia record
• from 40% to 41% of residents with no dementia record (Figure 1.5, ‘Percentage’).

For both groups, the percentage then decreased gradually to 30% and 36% respectively in the December 2022 quarter.

The average number of opioid scripts dispensed per resident decreased between the June 2019 and June 2022 quarters:

• from 5.4 to 4.9 per quarter for residents with a dementia record
• from 6.0 to 5.5 per quarter for residents with no dementia record (Figure 1.5, ‘Number’).

For downloadable data tables, see Table S1.3 in Data tables (Changes in health service use by aged care residents).

Psychotropic medication dispensing by population group

Figure 1.6 is an interactive chart where readers can explore differences in the dispensing of psychotropic medications, by dementia status and for selected population groups: sex, age group and region of residence (state or territory, remoteness area and socioeconomic area). 

It should be noted that changes in dispensing patterns between 2019 and 2022 may have been impacted by the COVID-19 pandemic and by regulatory changes introduced to try to address inappropriate prescribing of psychotropic drugs to aged care residents (Royal Commission 2021; Raban et al. 2025).

Some key findings are:

• Dispensing of psychotropic medicines tended to be lower in Remote and Very remote areas than in Major cities (Figure 1.6). However, in Very remote areas, dispensing of antidepressants increased from 33% of aged care residents with a dementia record in June 2021 to 48% in December 2022. This trend was not observed in other remoteness areas, or for residents with no dementia record.
• Residents in lower socioeconomic (most disadvantaged) areas were more likely to be dispensed antipsychotics and opioids and less likely to be dispensed dementia-specific medications than those in higher socioeconomic (least disadvantaged) areas (Figure 1.6).
• Women were more likely to be dispensed antidepressants, benzodiazepines and opioids; men were more likely to be dispensed antipsychotics; dispensing of dementia-specific medication was similar for men and women (Figure 1.6).
• Younger aged care residents were more likely to be dispensed antipsychotics, antidepressants and benzodiazepines and less likely to be dispensed opioids and dementia-specific medications than older residents (Figure 1.6).

For downloadable data tables, see Table S1.3 in Data tables (Changes in health service use by aged care residents).