Starting benzodiazepines or antipsychotics in hospice may increase the risk of death in people with Alzheimer’s disease and related dementias (ADRD), a study in JAMA Network Open has found.Lauren B. Gerlach, D.O., M.S., of the University of Michigan Medical School, and colleagues analyzed prescribing data on 139,103 nursing home residents with a primary or secondary diagnosis of ADRD who were newly enrolled in hospice. The researchers drew their data from national Medicare claims and Minimum Data Set assessments from July 1, 2014, to September 30, 2018—the only time that hospice agencies were required to report medications to Medicare.
Overall, among adults with ADRD who were at risk of exposure to benzodiazepines or antipsychotics, 47.8% and 13.4% initiated use in hospice, respectively.
The researchers matched 26,872 patients who began taking benzodiazepines in hospice with an equal number who did not, and 10,240 patients who began antipsychotics in hospice with an equal number who did not. (Some participants in each medication cohort were taking the other class of medication upon hospice enrollment.)
The researchers found that patients who had begun taking benzodiazepines and antipsychotics had a 41% and a 16% increased risk of dying within 180 days, respectively, compared with their matched peers who did not start the medications. The increased mortality risk remained significant when only including adults with a primary diagnosis of ADRD or only including those taking neither medication upon entering hospice.
Gerlach and colleagues noted that prior studies have revealed that prescribing of these medications varies significantly across hospice agencies, with rates ranging from 12% to 80% for benzodiazepines and 6% to 62% for antipsychotics.
“Whether a patient receives a benzodiazepine or an antipsychotic in hospice may depend more on agency practice norms than clinical presentation, which is concerning, especially in light of our findings that such exposure may adversely affect survival,” the researchers wrote. “[T]hese data underscore the need for dementia-specific hospice prescribing guidelines, investment in nonpharmacologic alternatives, and Medicare policy reform to track and inform safe medication use in hospice.”
For related information, see the Psychiatric News article “Behavioral, Psychological Symptoms of Dementia Require Tailored Care.”
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