A disproportionate number of older adults begin taking medications that affect cognition in the emergency department, during inpatient care, or in a nursing facility—even though they visit these settings infrequently, according to a report in JAMA Network Open.Further, even though they were prescribed the medications in an acute/post-acute care setting, a significant percentage of these patients were still taking the medications a year later.
Why It’s Relevant
Medications that adversely affect cognition may increase delirium and the risk of falls among older adults, but they remain frequently prescribed. Understanding where they are prescribed and how long patients are taking them may inform more judicious use of such medications.
By the Numbers
- Using data from the University of Michigan Health and Retirement Study, researchers identified 4,955 new prescriptions for benzodiazepines, nonbenzodiazepine hypnotics, antipsychotics, or anticholinergics among Medicare patients age 66 or older.
- Regardless of cognitive status—no impairment, cognitive impairment, or dementia—older adults were disproportionately more likely to be prescribed one of these cognitive-altering medications in an acute or post-acute setting compared with an office setting.
- For example, among patients with dementia who initiated an antipsychotic, just 22% of their overall visits were at acute or post-acute settings, but 43% of medication initiations occurred in those settings. Further, 67% of these patients were still taking an antipsychotic one year later.
- Across all four medication classes, 38% of patients with no cognitive impairment, 44% with cognitive impairment, and 51% with dementia who initiated a new medication continued to take a medication in the same class one year later.
The Other Side
The authors assumed that that the last setting before medication initiation was where the prescription originated, which may not have always been true.
Takeaway Message
All four of the medication classes assessed are listed in the BEERS Criteria as being potentially inappropriate in older adults. This study’s findings suggest that efforts to reduce long-term prescriptions of these medications might have the greatest impact if they target acute or post-acute settings.
Related Information
Source
Dan P. Ly, et. al. Initiation setting and persistence of medications affecting cognition in older adults. JAMA Open Network. Published April 28, 2026. doi:10.1001/jamanetworkopen.2026.10234
(Image: Getty Images/iStock/Gabrijelagal)
