Despite medical guidelines warning against their use, brain-altering drugs that can cause falls, confusion, and hospitalizations are still frequently prescribed to people with dementia.
A new study published in JAMA on January 12 reveals that around one in four Medicare patients with dementia are prescribed these medications.
Use of these medications has dropped slightly across the broader Medicare population—falling from 20% to 16% over a nine-year period. But among people with cognitive issues, prescription rates remain higher, even though these patients face increased risks.
“While the decline is encouraging, over two-thirds of patients receiving these prescriptions in 2021 lacked a documented medical reason,” said senior author Dr. John N. Mafi from UCLA’s David Geffen School of Medicine. “This suggests a large amount of potentially inappropriate and dangerous prescribing.”
Dr. Mafi emphasized that older adults with dementia are particularly vulnerable to the harmful effects of these drugs, such as increased confusion or risk of falls.
How the Study Worked
Researchers analyzed Health and Retirement Study surveys linked to Medicare fee-for-service data from 2013 to 2021. They tracked use of five classes of potentially inappropriate central nervous system (CNS)-active medications:
Antidepressants with strong anticholinergic properties
Antipsychotics
Barbiturates
Benzodiazepines (e.g., for anxiety)
Non-benzodiazepine hypnotics (e.g., sleep medications)
Key Findings
17% of older adults with normal cognition were prescribed these drugs
22% of those with cognitive impairment (but no dementia) received them
25% of those with dementia were prescribed them
Trends by Medication Type (2013–2021):
Benzodiazepine use fell from 11.4% to 9.1%
Sleep medication use dropped from 7.4% to 2.9%
Antipsychotic prescriptions rose from 2.6% to 3.6%
Anticholinergic antidepressants held steady at 2.6%
Barbiturate use slightly declined from 0.4% to 0.3%
Encouragingly, prescriptions with strong clinical justification dropped from 6% to 5.5%, while likely inappropriate prescriptions decreased from 15.7% to 11.4%. The biggest improvements came from reduced use of sleep and anxiety drugs.
However, the researchers cautioned that the study did not include Medicare Advantage data and may have missed some clinical information.
“Some CNS-active medications may be necessary,” said lead author Dr. Annie Yang. “But patients and caregivers should talk with their doctors to ensure these prescriptions are still needed—or whether safer alternatives exist.”
If you care about dementia, please read studies about dietary strategies to ward off dementia, and how omega-3 fatty acids fuel your mind.
For more health information, please see recent studies about Choline deficiency linked to Alzheimer’s disease, and what to eat (and avoid) for dementia prevention.
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