When older adults with dementia become restless at night, wander through hallways, or shout in confusion, the situation can be frightening for families and exhausting for caregivers.
These behaviors are often seen as dangerous, especially when there is a risk of falling or leaving home unsupervised. In response, doctors and care facilities sometimes turn to antipsychotic medications as a quick solution.
However, new research shows that this approach is becoming more common in the United States, even though it carries serious risks and offers limited benefits for people with dementia.
A new research letter published in JAMA Psychiatry by scientists from Rutgers University and Columbia University examined national prescription data to better understand how often antipsychotic drugs are being used in older adults.
The researchers analyzed prescription records covering more than 90 percent of retail pharmacy use in the United States. They focused on adults aged 65 and older between the years 2015 and 2024.
The results were striking. Over this nine-year period, the yearly rate of any antipsychotic use among older adults rose by nearly 52 percent. In 2015, about 2.7 out of every 100 older adults received an antipsychotic prescription.
By 2024, that number had grown to just over 4 out of every 100. Even more concerning was the rise in long-term use. Prescriptions lasting at least 120 days per year increased by 65 percent during the same period. Among people aged 75 and older, the rate climbed even higher, reaching more than 5 out of every 100 individuals.
This trend is worrying because antipsychotic medications are known to have limited effectiveness in treating dementia-related behaviors. They do not slow memory loss or improve thinking.
At the same time, they carry serious risks for older adults. These drugs come with a black-box warning stating they increase the risk of death in elderly patients with dementia. Other known dangers include falls, broken bones, heart problems, strokes, blood clots in the lungs, and extreme sedation.
Doctors sometimes prescribe antipsychotics as a last option when dementia-related behaviors become severe, such as aggression, intense agitation, hallucinations, or delusions that could harm the patient or others.
Even in these cases, experts agree that the drugs should be used for the shortest time possible. Yet the study suggests that many older adults are now receiving these medications for long periods, which increases the chance of harm.
One challenge the researchers faced is that prescription data do not include medical diagnoses. This means they could not see exactly why each drug was prescribed. Antipsychotics are still necessary for some people, including those with conditions such as schizophrenia or severe bipolar disorder with psychosis.
However, these illnesses are relatively uncommon in older age groups. According to the researchers, they are unlikely to explain the sharp rise in prescriptions.
The researchers believe a large part of the increase may be linked to dementia-related behaviors. In many care settings, medications are used to quiet actions that are distressing for staff or disruptive to routines.
Because antipsychotics are highly sedating, they can reduce wandering, shouting, and physical agitation. But this sedation often comes at a high cost. Frail older adults may become weaker, less mobile, and more likely to fall. Reduced movement can also worsen overall health and speed physical decline.
Another important finding from the study is a shift in who is managing these medications. In 2015, about 30 percent of older adults who used antipsychotics had at least one prescription written by a psychiatrist.
By 2024, that number had dropped to 20 percent. During the same period, prescriptions filled through long-term care pharmacies increased from 14 percent to 21 percent. This suggests that fewer patients are being evaluated by specialists before starting these powerful drugs.
This change matters because treating behavioral symptoms of dementia often requires careful assessment. Confusion and agitation can be caused or worsened by other problems, such as infections, unmanaged pain, depression, medication side effects, or drug interactions. Addressing these issues can sometimes reduce symptoms without the need for antipsychotics.
Even when dementia itself is the main cause, non-drug approaches such as routine adjustments, calming environments, staff training, and personalized care plans can be effective. These methods take time, staff, and resources, which are often limited in nursing homes and assisted living facilities.
The study did identify one small positive trend. The use of older, first-generation antipsychotic drugs declined over time. These medications are linked to even higher death rates than newer versions. However, this improvement does not outweigh the overall rise in antipsychotic use and long-term prescribing.
Taken together, the findings suggest that the health care system is relying more on medication to manage complex problems that are often rooted in staffing shortages, environmental stress, and unmet care needs. The researchers argue that greater effort is needed to expand and support non-drug treatments for dementia-related behaviors.
For families whose loved ones are prescribed an antipsychotic, the researchers encourage open conversations with clinicians.
It is reasonable to ask what specific problem the drug is meant to treat, whether other options have been tried, and whether there is a plan to reduce or stop the medication once the immediate crisis has passed. These decisions can have serious consequences for quality of life and safety.
In reviewing the study’s findings, it becomes clear that rising antipsychotic use reflects deeper challenges in dementia care. While medications may offer short-term control of difficult behaviors, they do not address underlying causes and can create new health risks.
The evidence strongly suggests that long-term reliance on these drugs may do more harm than good. Improving staffing levels, training caregivers, and prioritizing person-centered, non-drug approaches may offer safer and more effective ways to care for older adults living with dementia.
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