Brain-altering meds linked to falls, confusion being prescribed to 25% of older adults with dementia

This is a prescription for disaster.

While all medications carry potential side effects, certain types have been shown to increase the risk of falls, confusion and even hospitalization among older populations.

Despite the concerns, a new study found that 1 in 4 older Americans with dementia is still prescribed risky, brain-altering medications.

Older adults on Medicare are being prescribed sedatives and antipsychotic medications that affect the central nervous system (CNS), despite warnings from medical guidelines, according to a study published Monday in JAMA.

Researchers tracked prescribing patterns from Medicare fee-for-service claims between 2013 and 2021 to see how many CNS-active medications were given to adults with normal cognition, cognitive impairment without dementia or dementia.

These brain-altering drugs include antidepressants with strong anticholinergic properties, antipsychotics, barbiturates, benzodiazepines and non-benzodiazepine hypnotics.

While these prescriptions fell from 20% to 16%, the number of people who still use them is concerning to doctors, especially because those patients may have cognitive impairment that makes them more susceptible to the potentially dangerous side effects.

“While CNS-active prescriptions may be appropriate in some cases, it is important for older patients or their caregivers to work closely with their physicians to ensure that these medications are appropriate to their cases,” said study lead author and UCLA internal medicine resident Dr. Annie Yang.

These results support research from 2020 that found that nearly three-quarters of older adults in a group of Medicare beneficiaries filled a prescription for an opioid painkiller, an antipsychotic drug or an antidepressant.

None of the medications has been approved for dementia.

More than 7 million Americans over the age of 65 have been diagnosed with dementia, and that number is expected to double by 2050.

While there’s no known cure, some treatments target the underlying biology to slow progression.

Others manage the common symptoms of dementia related to memory, thinking, speaking, mood and agitation.

Unfortunately, certain antipsychotics and antidepressants seem to worsen cognitive decline.

That’s why it’s important to weigh the risks against the benefits since some drugs can increase confusion, sedation and aggression and even trigger dependence that can lead to withdrawal.

Consulting a doctor is helpful to monitor signs of dementia and identify the right treatment. It may not be brain-altering meds.

“When inappropriate, patients and their care teams should consider alternative treatments and consider whether it might be safe to taper or stop the medication,” Yang said.