One in Four Older Americans with Dementia Given Risky Medications

A significant health concern has emerged as research reveals that approximately one in four older Americans with dementia is prescribed brain-altering medications, despite long-standing safety warnings. This alarming trend persists even as overall prescriptions for such drugs have declined among Medicare beneficiaries. The research, set to be published on January 12, 2026, in the journal JAMA, underscores the need for better prescribing practices.

Over a nine-year period, the study observed that prescriptions for these medications decreased from 20% to 16% among Medicare beneficiaries. However, the rates remained notably high for individuals with cognitive impairment, particularly those diagnosed with dementia. Dr. John N. Mafi, the study’s senior author and an associate professor-in-residence at the David Geffen School of Medicine at UCLA, stated, “While this decline was encouraging, over two-thirds of patients receiving these prescriptions lacked a documented clinical indication in 2021, suggesting high levels of potentially inappropriate and harmful prescribing.”

Study Findings on Medication Prescribing Patterns

To conduct the study, researchers analyzed data from the Health and Retirement Study, linking it to Medicare fee-for-service claims. The focus was on prescribing patterns of central nervous system (CNS)-active medications from January 1, 2013, to December 31, 2021. The study examined five classes of CNS-active medications, including antidepressants with strong anticholinergic properties, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.

The findings revealed that CNS-active medications were prescribed to 17% of older adults with normal cognition, rising to 22% for those with cognitive impairment but without dementia. Alarmingly, about 25% of older adults with dementia received these medications. While clinically justified prescriptions decreased from 6% in 2013 to 5.5% in 2021, likely inappropriate prescriptions also fell significantly from 15.7% to 11.4% during the same period.

Recommendations and Implications for Care

Despite the overall decline in prescriptions, the study highlights significant opportunities to improve care quality and safety for older Americans. Dr. Annie Yang, a scholar in the National Clinician Scholars Program at Yale University and lead researcher, emphasized the importance of collaboration between older patients, their caregivers, and physicians. “While CNS-active prescriptions may be appropriate in some cases, it is vital to ensure that these medications are fitting for each individual case. Patients and their care teams should consider alternative treatments and discuss whether it is safe to taper or discontinue the medication,” said Dr. Yang.

The study’s limitations included the lack of available Medicare Advantage data and the potential absence of clinical information related to conditions like agitation. Nonetheless, these findings serve as a critical reminder of the need for vigilance in prescribing practices for older adults, particularly those with cognitive impairments.

The research involved contributions from several scholars, including Mei Leng, Dr. Dan Ly, Chi-Hong Tseng, Dr. Catherine Sarkisian, and Nina Harawa from UCLA, as well as Cheryl Damberg from RAND Corporation and Dr. A. Mark Fendrick from the University of Michigan. The need for enhanced prescribing guidelines is evident as healthcare professionals strive to safeguard the well-being of millions of older Americans affected by dementia and other cognitive impairments.