Medicines that affect the brain, such as antipsychotics and certain sleep drugs, are widely used in older adults. These drugs can sometimes help with symptoms like anxiety, sleep problems, or agitation.
However, they can also cause serious side effects, especially in people with memory problems or dementia.
A new study from researchers at the University of California, Los Angeles shows that many of these medications are first started in hospitals, emergency rooms, and nursing facilities rather than in regular doctors’ offices.
The research was published in JAMA Network Open. It focused on adults aged 66 years and older and used data from a large national survey called the Health and Retirement Study, which was linked to Medicare records.
By examining this data, the researchers were able to see when and where people first received prescriptions for medications that can affect thinking and memory.
The study looked at four main types of drugs. These included benzodiazepines, which are often used for anxiety or sleep, nonbenzodiazepine sleep medicines, antipsychotics, and anticholinergics.
All of these drugs can influence brain function and may lead to side effects such as confusion, falls, or a sudden worsening of mental state, especially in older adults.
One of the key findings was that a large number of these medications were first prescribed in acute or post-acute care settings.
These include places like emergency departments, hospitals, and skilled nursing facilities. This was surprising because many people assume that most prescriptions begin in a doctor’s office.
The study found that older adults with dementia were especially likely to receive these medications in these settings.
About 22 percent of people with dementia started one of these drugs in a hospital or similar setting. Even among people without memory problems, about 14 percent received such prescriptions in these environments.
Another important finding was that once these medications were started, many patients continued taking them for a long time. For people with dementia, more than half were still using these drugs one year later. This suggests that these medications can become part of long-term treatment, even if they were originally intended for short-term use.
This pattern raises concerns because older adults with memory problems are more sensitive to the side effects of these drugs.
They are at higher risk of falling, becoming confused, or needing hospital care. These risks make it important to carefully consider when and where these medications are started.
The researchers believe that focusing on hospitals and care facilities could be key to reducing unnecessary or risky prescribing. If doctors and healthcare providers in these settings are more cautious, it could have a large impact on patient safety.
The study also highlights a broader issue in healthcare. Previous research has shown that many prescriptions for brain-active medications do not have a clearly documented reason. This suggests that some patients may be receiving these drugs without strong evidence that they are needed.
At the same time, the study has some limitations. The researchers assumed that the last healthcare setting a patient visited was where the prescription was started, which may not always be correct. More research is needed to better understand the decision-making process behind these prescriptions.
When we look at the findings carefully, the study provides strong evidence that the place where care is delivered can influence treatment decisions. Its large sample size and use of real-world data make the results reliable. However, it also shows that there is still uncertainty about why these medications are prescribed so often in certain settings.
Overall, this research sends a clear message. To reduce harm and improve care for older adults, especially those with dementia, healthcare systems need to focus on where risky medications are being started. By targeting hospitals and similar settings, it may be possible to make meaningful improvements in patient safety.
If you care about stroke, please read studies about how to eat to prevent stroke, and diets high in flavonoids could help reduce stroke risk.
For more health information, please see recent studies about how Mediterranean diet could protect your brain health, and wild blueberries can benefit your heart and brain.
