Despite clear guidelines, millions with dementia are still prescribed risky medications, sparking concern over patient safety.
Story Overview
- 25% of Medicare patients with dementia receive CNS-active medications.
- These drugs are linked to increased risks of falls and confusion.
- 66% of prescriptions in 2021 lacked documented justification.
- Despite some progress, antipsychotic prescriptions have risen.
Alarming Trends in Dementia Care
A study led by UCLA, published in *JAMA* reveals an unsettling trend: millions of dementia patients are still being prescribed central nervous system (CNS)-active medications despite long-standing guidelines against their use. From 2013 to 2021, 25% of Medicare beneficiaries with dementia received these drugs, including benzodiazepines and antipsychotics, known for their severe side effects like falls and confusion. This is a significant concern, given that over two-thirds of 2021 prescriptions lacked documented clinical justification.
Overall prescribing of CNS-active medications declined from 20% to 16% among all Medicare beneficiaries during the study period. However, the rate remained highest among those with dementia. The increase in antipsychotic prescriptions, rising from 2.6% to 3.6%, is particularly troubling. This underscores a persistent gap in the application of clinical guidelines, raising questions about the quality of care provided to this vulnerable population.
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Guideline Warnings and Persistent Prescribing
Clinical guidelines, such as the Beers Criteria, have warned against the use of CNS-active medications in older adults with dementia for years. These drugs can disrupt neurotransmitter systems like dopamine and serotonin, leading to severe side effects. Despite this, the practice persists due to factors like clinician inertia and a lack of suitable alternatives for symptoms such as agitation or insomnia. The study highlights a need for more comprehensive documentation and a shift towards safer, evidence-based treatment methods.
The study’s findings are based on an analysis of Medicare fee-for-service claims linked to Health and Retirement Study data, covering a nine-year period. It excluded Medicare Advantage data, which might mean the actual prevalence of such prescriptions is even higher. Researchers noted that while there was a decline in the use of drugs like benzodiazepines and hypnotics, the increase in antipsychotic prescriptions is alarming.
Impact on Patients and Healthcare System
For millions of Medicare beneficiaries with dementia, the implications of this study are profound. The continued use of these medications not only increases the risk of falls and hospitalization but also diminishes the quality of life for patients and their caregivers. Economically, reducing unnecessary hospitalizations could save billions annually, as falls alone cost the healthcare system an estimated $50 billion each year.
Millions with dementia still prescribed drugs linked to falls and confusion https://t.co/og4WZzSb1d
— #TheRebelDemocrat (@ejnyamogo) January 14, 2026
Socially, improving adherence to guidelines would mean better patient outcomes and less strain on caregivers. Politically, these findings could exert pressure on Medicare to enforce stricter oversight and accountability measures. The study calls for a concerted effort to enhance the safety and efficacy of dementia care, focusing on documented clinical justifications for prescriptions and exploring alternative therapies.
Expert Opinions and Future Directions
Dr. John N. Mafi, the senior author of the study, emphasizes the need for improved care quality, highlighting the high levels of potentially inappropriate prescribing. Dr. Annie Yang, the lead author, advocates for patient-physician collaboration to consider alternatives and tapering off these risky medications. The study’s publication has prompted calls for more stringent guidelines and policy interventions to prevent unjustified prescribing practices.
The findings from UCLA’s study have reignited discussions about the balance between managing dementia symptoms and minimizing medication risks. By reinforcing the importance of guideline adherence and patient safety, this research could play a pivotal role in shaping future dementia care strategies. As awareness grows, the hope is for a shift towards more responsible prescribing practices that prioritize the well-being of patients.
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