Newly prescribed Benzodiazepine or Antipsychotic Use tied to Higher Mortality in Dementia Patients: JAMA
A case-control study of Medicare data has found that older adults with Alzheimer’s disease or other forms of dementia who were newly prescribed benzodiazepines or antipsychotics in hospice care had higher mortality compared with those not receiving these medications. The study, published in JAMA Network Open by Wang L. and colleagues, analyzed prescribing patterns and outcomes in a large population of hospice patients. Researchers noted that these medications were typically initiated about three days after hospice enrollment, with patients having an average hospice stay of over 135 days. The findings underscore the potential risks associated with psychotropic medication use in vulnerable populations with advanced cognitive decline.
The study examined the clinical context and timing of medication initiation, highlighting that while benzodiazepines and antipsychotics may be prescribed to manage agitation, anxiety, or behavioral symptoms, their use can be associated with adverse outcomes including increased mortality. Researchers emphasized that patients receiving these drugs should be closely monitored, and alternative non-pharmacologic interventions should be considered whenever possible. The analysis also revealed that mortality risk was higher regardless of the specific medication class, pointing to the importance of evaluating overall patient frailty and comorbidities when prescribing these treatments in hospice.
The authors concluded that careful prescribing practices and dementia-specific hospice guidelines are essential to minimize harm. They recommended that clinicians weigh the potential benefits and risks of benzodiazepines and antipsychotics, prioritize symptom management through safer alternatives, and involve caregivers in shared decision-making. The study supports the development of evidence-based protocols tailored to the unique needs of dementia patients in hospice, aiming to improve both safety and quality of end-of-life care.
Reference :
Wang, L., et al. (2020). Newly Prescribed Benzodiazepine or Antipsychotic Use Tied to Higher Mortality in Dementia Patients: A Case-Control Study. JAMA Network Open, 3(10), e2012102. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2840039
Keywords:
benzodiazepines, antipsychotics, dementia, Alzheimer’s disease, hospice care, JAMA Network Open, Wang L., mortality, prescribing practices.
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