Hospice care is meant to bring comfort, peace, and dignity to people in the final stage of life. For many Americans with dementia who enter hospice, their path is often long and unpredictable.
Because of this, it’s very important to make sure treatments match the person’s wishes and stage of illness.
A new study from the University of Michigan, published in JAMA Network Open, has raised concerns about the safety of some common medications given to people with dementia in hospice. These drugs, which are often used to help with agitation, anxiety, and confusion, may actually increase the risk of death in this group.
Researchers studied more than 139,000 people in nursing homes who had dementia and were enrolled in hospice between 2014 and 2018.
They found that people who started taking either benzodiazepines or antipsychotics after joining hospice were more likely to die within six months compared to similar patients who didn’t take those drugs. The risk of death was 41% higher for those who took benzodiazepines and 16% higher for those who took antipsychotics.
Dr. Lauren Gerlach, a psychiatrist and lead author of the study, explained that many dementia patients in hospice are not in the last days of life. In fact, nearly one in five people with dementia live longer than six months after entering hospice. This makes it even more important to use medicines that improve quality of life, rather than potentially shorten it.
The researchers used national Medicare data during a special period when hospices had to report what medications they prescribed. None of the patients had been given these medications in the six months before entering hospice.
Still, 48% received a new benzodiazepine prescription and 13% received a new antipsychotic after hospice started. Most prescriptions happened in the first few days of care. These medicines include drugs like Ativan and Valium (benzodiazepines), and Haldol and Zyprexa (antipsychotics).
The average time patients spent in hospice was over 130 days, which means most were not in the very final stage of life. Dr. Gerlach pointed out that some hospices might use these medications as part of routine care, rather than based on each person’s individual needs.
While these drugs can offer relief from distress, they also come with serious risks for older adults, such as drowsiness, confusion, and a higher chance of falls. The FDA even has warning labels on antipsychotic medications because they can raise the risk of death in dementia patients. Benzodiazepines have similar warnings.
There are also problems with how these medications are tracked and reported. Medicare no longer requires hospices to report which drugs are given, which makes it hard to monitor safety or quality. In nursing homes, these drugs are closely tracked and can affect a facility’s rating. But in hospice, there’s no such system.
Another issue is that hospice rules were originally created for people with cancer, who usually have a clear and short disease path. But dementia often progresses slowly and unpredictably. About 20% of dementia patients live longer than the six-month hospice limit and are discharged, even though they still need care.
Earlier research from the same team also showed big differences in how often different hospice agencies use these drugs.
For example, the percentage of patients prescribed benzodiazepines ranged from 12% to 80% depending on the hospice agency. For antipsychotics, the range was 6% to 62%. For-profit and large agencies were more likely to prescribe them.
This wide difference suggests that some hospices may be guided more by policy or habit than by what’s best for each patient. Since 60% of people with dementia will enter hospice at some point, and that number is rising, these findings are a wake-up call.
The researchers say we need better ways to track medication use in hospice and better training for doctors and nurses. That way, they can make choices based on solid evidence and the specific needs of each person with dementia.
If you care about dementia, please read studies about low choline intake linked to higher dementia risk, and how eating nuts can affect your cognitive ability.
For more information about brain health, please see recent studies that blueberry supplements may prevent cognitive decline, and results showing higher magnesium intake could help benefit brain health.
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