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Medications that influence the brain, such as antipsychotics and certain sleep aids, are commonly prescribed to older adults. These drugs can sometimes effectively manage symptoms like anxiety, sleep disturbances, or agitation. However, they also carry the risk of serious side effects, particularly in individuals with memory issues or dementia.
A recent study conducted by researchers at UCLA reveals that many of these medications are initiated in hospitals, emergency rooms, or nursing homes instead of through routine visits to a doctor’s office. The findings, published in JAMA Network Open, focused on adults aged 66 and older and utilized data from the nationwide Health and Retirement Study, linked with Medicare records. This enabled researchers to analyze when and where individuals first received prescriptions for drugs that impact cognition and memory.
The study primarily examined four categories of medications: benzodiazepines (used for anxiety and sleep), nonbenzodiazepine sleep medications, antipsychotics, and anticholinergics. All of these can affect mental function and may cause side effects like confusion, falls, or sudden mental decline—especially among senior populations.
A noteworthy discovery was that a significant number of these drugs were first prescribed in acute or post-acute care environments, including emergency departments, hospitals, and skilled nursing facilities. This was unexpected, as many presume prescriptions begin in outpatient doctor visits. The study highlighted that seniors with dementia are particularly prone to receiving these medications in such settings, with approximately 22% of them starting a drug in hospitals or similar environments. Even among seniors without memory issues, about 14% received these prescriptions in acute care settings.
Furthermore, the research found that once initiated, many patients remained on these medications for extended periods. More than half of those with dementia continued using the drugs after one year, indicating these medications often become part of long-term treatment plans, even if originally prescribed for short-term use. This trend raises concerns, as older adults with cognitive impairment are more susceptible to adverse effects, such as falls, confusion, and increased hospitalizations.
The study emphasizes that hospitals and care facilities represent critical points where prescribing practices can be improved. By being more cautious during these encounters, healthcare providers could significantly reduce unnecessary and potentially harmful medication use in vulnerable seniors. The findings also underscore a broader issue: prior research has shown that many prescriptions for drugs affecting brain function lack clear justification, suggesting some patients may be on these medications without solid evidence of necessity.
Limitations of the study include the assumption that the patient’s last healthcare visit was the setting where the medication was first prescribed, which might not always be accurate. Further research is needed to uncover the rationale behind these prescribing decisions.
Overall, the evidence demonstrates that the setting of care delivery heavily influences prescribing behaviors. Given the sizable sample and real-world data, these findings are reliable, although some uncertainty remains regarding the exact reasons these medications are so frequently prescribed in specific environments.
In conclusion, targeting hospitals and nursing facilities as focal points for intervention could be instrumental in reducing unnecessary exposure to risky medications. Improving prescribing practices in these settings has the potential to greatly enhance patient safety for older adults, especially those with dementia.
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