Medications that affect the brain can be helpful in some situations, but they can also carry serious risks, especially for older adults.
A new study from UCLA has found that many of these drugs are first prescribed in hospitals, emergency rooms, and nursing homes instead of regular clinics.
This discovery may help explain why these medications are used so widely and why some patients continue taking them for long periods.
The study was published in JAMA Network Open and examined data from thousands of older adults across the United States.
The researchers used information from the Health and Retirement Study linked with Medicare data, covering many years of medical care. This allowed them to track where prescriptions began and how long patients continued to use the medications.
The focus was on drugs known to affect thinking and memory. These included antipsychotics, drugs for anxiety and sleep, and medications with anticholinergic effects. While these drugs can be useful, they can also cause problems such as confusion, dizziness, and an increased risk of falling.
The results showed that a large share of these prescriptions began in acute care settings. These are places where patients often receive urgent or short-term treatment, such as hospitals or emergency departments. Post-acute settings, like skilled nursing facilities, also played a major role.
For people with dementia, the numbers were especially high. Nearly one in four started these medications in such settings. Even among those without cognitive problems, a significant number received their first prescription outside of a doctor’s office.
Another key finding was that many patients continued using these drugs long after they were first prescribed. For people with dementia, more than half were still taking them after one year. This suggests that medications started during a hospital stay may become part of ongoing treatment, even if they were not meant for long-term use.
This pattern is concerning because older adults are more vulnerable to the side effects of these drugs. They may experience worsening confusion, increased risk of falls, or even hospitalization. These risks highlight the need for careful prescribing practices.
The researchers suggest that efforts to reduce unnecessary use of these medications should focus on hospitals and care facilities. These settings may be the best place to intervene and ensure that prescriptions are only given when truly needed.
The study also builds on earlier research showing that many prescriptions for brain-related medications do not have a clear medical reason recorded. This points to a larger issue in healthcare, where some treatments may be used without strong evidence of benefit.
However, the study also has limitations. It relies on data that cannot always show exactly where a prescription was started. In addition, it does not fully explain why certain providers prescribe these medications more often than others.
Despite these limitations, the study provides valuable insight into prescribing patterns. Its large dataset and long time period make the findings meaningful and relevant. It also highlights an area where simple changes could lead to better outcomes for patients.
In summary, this research shows that the setting of care plays a major role in how medications are prescribed. By improving practices in hospitals and similar environments, it may be possible to reduce risks and improve the health of older adults.
The findings are an important step toward safer and more thoughtful use of medications that affect the brain.
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Source: UCLA.
