KEY POINTS
- A nine-year study found that one in four Medicare beneficiaries with dementia still receives potentially dangerous CNS-active drugs.
- While overall prescriptions for brain-altering medications fell from 20% to 16%, use actually rose for patients with cognitive impairment.
- Over 70% of risky prescriptions lacked a documented clinical reason in 2021, increasing the danger of falls and hospitalizations.
A comprehensive study published in JAMA reveals a persistent public health challenge in the United States. Many older adults continue to receive central nervous system (CNS) medications that medical guidelines label as high-risk. These drugs, which include antipsychotics and benzodiazepines, often cause severe side effects in aging bodies. For seniors, the consequences frequently include delirium, physical confusion, and life-threatening falls.
Researchers from Yale and UCLA tracked Medicare data from 2013 through 2021 to identify prescribing trends. They focused on five specific classes of drugs known to be potentially inappropriate for patients over 65. The data showed a slight overall decrease in these prescriptions among the general senior population. However, the study uncovered a troubling disparity for those suffering from cognitive decline or dementia.
Patients with dementia were far more likely to be prescribed these brain-altering substances than those with normal cognition. Roughly 25% of beneficiaries with dementia received at least one risky CNS-active prescription by the end of the study. This group is particularly vulnerable because they may struggle to communicate the side effects they experience. Health experts warn that the risks of these drugs often outweigh the benefits for this population.
Perhaps the most alarming finding involves the lack of medical justification for these medications. In 2021, more than two-thirds of the high-risk prescriptions analyzed lacked a documented clinical indication. This suggests that many providers may be using the drugs off-label to manage behavioral symptoms. Using antipsychotics to treat agitation in dementia patients is a common but discouraged practice.
The slight downward trend in overall prescribing was driven mostly by a reduction in sleep aids and benzodiazepines. In contrast, the use of antipsychotic medications actually increased during the nine-year study period. Anticholinergic antidepressants also remained at steady levels despite their link to increased cognitive impairment. These specific trends indicate that medical warnings have not reached every segment of geriatric care.
Medical leaders are now calling for more rigorous medication reviews for older adults and their caregivers. They recommend exploring non-drug alternatives for managing the behavioral challenges associated with aging. When drugs are necessary, they should be used at the lowest possible dose for the shortest time. This proactive approach is essential to reduce unnecessary hospitalizations and improve the quality of life for seniors.
