Risky Prescriptions Persist for One in Four Older Americans with Dementia

A significant number of older Americans diagnosed with dementia continue to receive potentially harmful medications, according to research scheduled for publication on January 12, 2026, in the journal JAMA. Despite clinical guidelines cautioning against such practices, approximately one in four Medicare beneficiaries with dementia are prescribed brain-altering drugs that are associated with serious side effects, including falls, confusion, and hospitalization.

The study reveals a concerning trend. While the overall prescription rate for these medications among all Medicare beneficiaries decreased from 20% to 16% over a nine-year period, individuals with cognitive impairments remain at significant risk. In fact, over two-thirds of patients prescribed these medications in 2021 did not have a documented clinical justification, indicating widespread inappropriate prescribing practices.

Examination of Prescription Patterns

Led by Dr. John N. Mafi, an associate professor-in-residence of medicine at the David Geffen School of Medicine at UCLA, the researchers utilized survey data from the Health and Retirement Study linked to Medicare fee-for-services claims. Their analysis covered the prescribing patterns of central nervous system (CNS)-active medications from January 1, 2013, through December 31, 2021. The study specifically focused on three groups: older adults with normal cognition, those with cognitive impairment without dementia, and those diagnosed with dementia.

The types of medications examined included five classes: antidepressants with strong anticholinergic properties, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics. The findings indicated that while 17% of older adults with normal cognition were prescribed CNS medications, this figure rose to 22% for those with cognitive impairment and 25% for individuals diagnosed with dementia.

Prescription trends showed a decline in clinically justified prescriptions, which fell from 6% in 2013 to 5.5% in 2021. Conversely, prescriptions deemed likely inappropriate saw a notable decrease from 15.7% to 11.4%. This improvement was largely attributed to reduced prescriptions for benzodiazepines and sleep medications.

Addressing the Challenges in Prescription Practices

While the study presents important findings, it is essential to note its limitations. The researchers did not have access to Medicare Advantage data, which may have excluded relevant clinical information regarding agitation and focused primarily on prescribing prevalence rather than cumulative exposure to these medications.

Dr. Annie Yang, a scholar in the National Clinician Scholars Program at Yale University and the lead author of the study, emphasized the importance of careful monitoring of medication use. “While CNS-active prescriptions may be appropriate in some cases, it is crucial for older patients or their caregivers to collaborate closely with their physicians to confirm that these medications are suitable for their specific conditions,” she explained. “When prescriptions are inappropriate, patients and their care teams should explore alternative treatments and consider whether it might be safe to taper or discontinue the medication.”

The study’s co-authors include Mei Leng, Dr. Dan Ly, Chi-Hong Tseng, Dr. Catherine Sarkisian, and Nina Harawa of UCLA, along with Cheryl Damberg from RAND Corporation and Dr. A. Mark Fendrick from the University of Michigan. Both Dr. Ly and Dr. Sarkisian are also affiliated with the VA Greater Los Angeles Healthcare System.

With millions of older Americans affected by dementia, addressing these prescribing patterns is critical to improving the quality and safety of care for this vulnerable population. The study serves as a call to action for healthcare providers to reassess their prescribing practices and prioritize patient safety.