Even though doctors have been warned for years not to use certain brain-affecting medications in people with dementia, a new study shows that one in four Medicare patients with dementia is still being prescribed these risky drugs.
These medications are linked to harmful side effects such as falls, confusion, and hospital visits. The study will be published in the journal JAMA.
Researchers found that while the overall number of these prescriptions dropped from 20% to 16% over a nine-year period, the drugs are still commonly given to people with memory problems—the very group most vulnerable to their negative effects.
Dr. John N. Mafi, the senior author of the study and a professor at UCLA’s David Geffen School of Medicine, said it was concerning that in 2021, more than two-thirds of the patients who received these prescriptions did not have a clear medical reason for them.
This suggests that many of these prescriptions may not only be unnecessary but could be harmful. Dr. Mafi emphasized the need to improve the care and safety of older adults with memory issues.
The research team looked at data from Medicare between 2013 and 2021. They used information from the Health and Retirement Study and compared it with Medicare insurance claims to see how often certain central nervous system (CNS)-active medications were being prescribed.
These drugs affect the brain and include antidepressants with anticholinergic effects, antipsychotics, barbiturates, benzodiazepines (like Valium), and sleep aids known as non-benzodiazepine hypnotics.
The results showed that 17% of seniors with normal memory were prescribed one of these drugs. But for people with some memory problems, that number rose to almost 22%. For people with diagnosed dementia, it was even higher—about 25% were given these potentially harmful medications.
Over time, the study found some improvement. Prescriptions for benzodiazepines fell from 11.4% to 9.1%, and prescriptions for non-benzodiazepine sleep drugs dropped from 7.4% to 2.9%.
These reductions likely helped improve safety overall. However, the use of antipsychotics increased slightly from 2.6% to 3.6%. Prescriptions for barbiturates decreased slightly, and anticholinergic antidepressants remained steady at 2.6%.
The number of prescriptions that were clinically justified dropped slightly from 6% in 2013 to 5.5% in 2021. Meanwhile, prescriptions that were likely inappropriate fell more noticeably, from 15.7% to 11.4%. Most of this progress came from fewer prescriptions for sleep aids and benzodiazepines.
Still, the study had some limitations. It did not include data from Medicare Advantage plans, which means some patient records were not available. Also, some symptoms like agitation may not have been recorded in the data, and the study only looked at how often the drugs were prescribed—not how long people took them.
Dr. Annie Yang, who led the research while she was a resident at UCLA and is now part of Yale’s National Clinician Scholars Program, pointed out that while these medications can sometimes be helpful, older adults and their caregivers need to carefully discuss them with their doctors.
In many cases, it may be better to find other treatment options or to gradually stop using the drugs altogether.
The study was a team effort involving researchers from UCLA, RAND, Yale, the University of Michigan, and the VA Greater Los Angeles Healthcare System.
The bottom line: progress is being made, but many older adults with dementia are still being prescribed medications that could do more harm than good. More work is needed to ensure safer, more appropriate care.
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