A significant number of older Americans with dementia are being prescribed potentially harmful medications, despite long-standing safety warnings. New research indicates that approximately one in four Medicare beneficiaries diagnosed with dementia has received prescriptions for brain-altering drugs linked to adverse effects such as confusion and falls. The study will be published in the journal JAMA on January 12, 2026.
Over the course of a nine-year study, the overall prescription rate for these medications dropped from 20% to 16% among all Medicare beneficiaries. However, the decline is less pronounced in patients with cognitive impairments. According to the study’s senior author, Dr. John N. Mafi, an associate professor at the David Geffen School of Medicine at UCLA, the findings reveal alarming trends in prescribing practices. “Two-thirds of patients receiving these prescriptions lacked a documented clinical indication in 2021, suggesting high levels of potentially inappropriate and harmful prescribing,” he stated.
Study Methods and Medication Types
The researchers utilized data from the Health and Retirement Study linked to Medicare fee-for-service claims. They examined the prescribing patterns of central nervous system (CNS)-active medications from January 1, 2013, to December 31, 2021. The study focused on three groups: older adults with normal cognition, those with cognitive impairment without dementia, and individuals diagnosed with dementia. The CNS-active medications included five drug classes: antidepressants with strong anticholinergic properties, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.
Among the findings, prescriptions for CNS medications were noted in 17% of older adults with normal cognition, while nearly 22% of those with cognitive impairment without dementia received these drugs. Alarmingly, around 25% of individuals in the dementia group were prescribed CNS-active medications.
Trends and Findings in Prescribing Practices
The study also examined prescription trends among all Medicare fee-for-service beneficiaries. Clinically justified prescriptions decreased from 6% in 2013 to 5.5% in 2021. Conversely, likely inappropriate prescriptions for CNS-active medications dropped significantly from 15.7% to 11.4%. This positive shift is attributed largely to reductions in the use of benzodiazepines and sleep medications.
Despite these improvements, the study’s limitations include the absence of Medicare Advantage data and potential gaps in clinical information, such as the presence of agitation. The research primarily focused on prescribing prevalence rather than cumulative exposure to these medications.
Dr. Annie Yang, a scholar in the National Clinician Scholars Program at Yale University, emphasized the importance of collaboration between older patients or their caregivers and healthcare providers. “While CNS-active prescriptions may be appropriate in some cases, it is vital to ensure that these medications are suitable for individual circumstances,” she noted. Dr. Yang led the study as a resident at UCLA and underscored the need for care teams to explore alternative treatments when prescriptions are inappropriate.
The co-authors of the study include Mei Leng, Dr. Dan Ly, Chi-Hong Tseng, Dr. Catherine Sarkisian, and Nina Harawa from UCLA, as well as Cheryl Damberg from RAND and Dr. A. Mark Fendrick from the University of Michigan. Drs. Ly and Sarkisian are also associated with the VA Greater Los Angeles Healthcare System.
This research highlights critical opportunities to enhance the quality and safety of care for millions of older Americans. As the population ages, addressing these prescribing patterns is essential for improving health outcomes among vulnerable groups.
