One in Four Older Americans with Dementia Prescribed Risky Medications

A troubling trend persists among older Americans with dementia, as research reveals that one in four Medicare beneficiaries is prescribed brain-altering medications despite established safety warnings. This study, set to be published on January 12, 2026, in the journal JAMA, highlights ongoing concerns regarding the appropriateness of such prescriptions.

Conducted over a nine-year period, the research indicates that while overall prescriptions for these medications decreased from 20% to 16% among all Medicare beneficiaries, individuals with cognitive impairment remain particularly vulnerable. “Over two-thirds of patients receiving these prescriptions lacked a documented clinical indication in 2021, suggesting high levels of potentially inappropriate and harmful prescribing,” stated Dr. John N. Mafi, senior author and associate professor at the David Geffen School of Medicine at UCLA.

Study Findings and Implications

The study utilized data from the Health and Retirement Study linked to Medicare fee-for-service claims. It examined prescribing patterns of central nervous system (CNS)-active medications from January 1, 2013, to December 31, 2021. The researchers focused on three groups: older adults with normal cognition, those with cognitive impairment without dementia, and individuals diagnosed with dementia.

Among those with normal cognition, CNS-active medications were prescribed to approximately 17%. The figure rose to nearly 22% for individuals with cognitive impairment but no dementia. Alarmingly, about 25% of the dementia group received these medications. The study specifically analyzed five drug classes, including antidepressants with strong anticholinergic properties, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.

Prescription trends showed that clinically justified prescriptions fell from 6% in 2013 to 5.5% in 2021. In contrast, likely inappropriately prescribed CNS-active medications declined significantly from 15.7% to 11.4%. This improvement was largely attributed to reduced prescriptions for benzodiazepines and sleep medications.

Recommendations and Future Directions

While the decline in prescriptions is welcome, the findings reveal significant opportunities to enhance the quality and safety of care for millions of older Americans. Dr. Annie Yang, who led the study as a resident at UCLA, emphasized the importance of communication between older patients, their caregivers, and physicians. “When medications are deemed inappropriate, patients and their care teams should consider alternative treatments and assess whether it might be safe to taper or stop the medication,” she advised.

Despite the study’s insights, limitations exist, including the absence of Medicare Advantage data and potential gaps in clinical information. The focus on prescribing prevalence rather than cumulative exposure has also been noted.

As the medical community continues to grapple with the implications of CNS-active medications for older adults, the findings underscore the need for vigilant prescribing practices. With millions affected, ensuring safe and appropriate treatment for older individuals, particularly those with cognitive impairments, remains a pressing concern.

The co-authors of the study include Mei Leng, Dr. Dan Ly, Chi-Hong Tseng, Dr. Catherine Sarkisian, and Nina Harawa from UCLA, along with Cheryl Damberg from RAND and Dr. A. Mark Fendrick from the University of Michigan.