Psychotropic Drug Use in Dementia: Need for Caution

Recent research conducted by UCLA has revealed concerning statistics regarding the ongoing prescription of psychotropic medications among older adults with dementia. The findings indicate that nearly 50% of older patients who are prescribed these medications continue their use a year after starting them, raising concerns about their long-term effects.

The Nature of Psychotropic Prescriptions

Psychotropic medications, notably antipsychotics and benzodiazepines, are often prescribed to manage symptoms associated with cognitive decline. However, these medications can exacerbate issues such as confusion, delirium, and the risk of falls, especially in vulnerable populations, including those with dementia. Dr. Dan Ly, the lead author of the research, states:

“Medications such as antipsychotics and benzodiazepines are known to affect cognition, increase delirium, and increase fall risk for older adults.”

Key Findings from the Study

The researchers based their study on data from the Health and Retirement Study (HRS), analyzing Medicare fee-for-service claims between January 1, 2008, and December 31, 2021. A significant aim was to evaluate the settings in which medications affecting cognition are initially prescribed. Below is a summary of the data analyzed:

Notably, there is a stark contrast observed in the initial prescription locations. Among patients diagnosed with dementia, 43% of antipsychotic prescriptions originated from acute and post-acute care settings, compared to only 22% of overall patient visits. This pattern suggests that medications affecting cognition have a higher likelihood of being initiated in hospitals and skilled nursing facilities than in outpatient settings.

Implications for Healthcare Systems

The implications of these findings are profound, highlighting the need to reform prescription practices in acute and post-acute care environments. The ongoing usage of cognition-altering medications among older adults necessitates a reevaluation of their prescribing practices. Dr. Ly notes:

“Our results suggest that efforts to reduce these prescriptions might have the greatest impact if we focus on acute and post-acute settings.”

Limitations and Future Research

While the study provides valuable insights, it also has its limitations, chiefly the assumption that the last healthcare setting attended was where the prescription originated. Future research will aim to explore the characteristics of healthcare providers responsible for these prescriptions and the clinical indications accompanying them. Dr. John N. Mafi, the study's senior author, emphasized:

“Our latest study gives policymakers and clinicians a roadmap, pointing exactly to where they should target their interventions first: acute and post-acute care settings.”

This study builds upon prior research indicating a high percentage of prescriptions lacking clear clinical indications, underscoring the urgency of addressing overprescribing practices.

Conclusions

The evidence suggests that there is a critical need for healthcare professionals to remain vigilant regarding the prescription of psychotropic medications to older adults with dementia. By focusing on enhancing prescription oversight in acute settings, the risk of prolonged medication use can be mitigated, ultimately leading to better health outcomes for this vulnerable population.

References

[1] Ly, D., et al. (2026). Initiation Setting and Persistence of Medications Affecting Cognition in Older Adults, JAMA Network Open.

[2] Mafi, J. N., et al. (2026). Inadequate Clinical Indications for Psychotropic Medications in Older Adults. The Lancet Public Health.

[3] Centers for Disease Control and Prevention. (2021). Falls Among Older Adults: An Overview. Retrieved from CDC - Falls Among Older Adults

[4] Alzheimer's Association. (2026). Dementia Care Practices. Retrieved from Alzheimer's Association