The percentage of older adults receiving potentially inappropriate psychotropic medications has been declining since 2013, according to a report published today in JAMA. Still, in 2021, more than two-thirds of adults who were prescribed a potentially inappropriate drug did not have a documented clinical justification for the prescription.Why It’s Relevant
Clinical guidelines have repeatedly cautioned against the use of certain central nervous system (CNS)–targeting medications in older adults, particularly those with cognitive impairment, because they increase the risk of falls, delirium, and hospitalizations.
As defined by the Beers Criteria, potentially inappropriate CNS medications include benzodiazepines, nonbenzodiazepine hypnotics, barbiturates, antipsychotics, and antidepressants with anticholinergic side effects (such as tricyclics).
By the Numbers
- Between 2013 and 2021, the percentage of Medicare beneficiaries receiving one or more potentially inappropriate CNS medications declined from 19.9% to 16.2%.
- The decline was primarily driven by reductions in the prescribing of benzodiazepines and nonbenzodiazepine hypnotics.
- Among Medicare beneficiaries receiving one of the CNS medications in 2021, 70% did not have a documented indication for use (such as prescribing an antipsychotic for schizophrenia or depression).
The Other Side
Agitation, which may sometimes warrant the use of these medications, wasn’t included as a justified clinical indication. The dataset also didn’t include Medicare Advantage beneficiaries.
Takeaway Message
“It is important for older patients or their caregivers to work closely with their physicians to ensure that [CNS] medications are appropriate to their cases,” lead author Annie Yang, M.D., said in a press release. “When inappropriate, patients and their care teams should consider alternative treatments and consider whether it might be safe to taper or stop the medication.”
Related Information
Source
Annie W. Yang, et al. Prescribing patterns of potentially inappropriate CNS-active medications in older adults. JAMA. Published January 12, 2026. doi: 10.1001/jama.2025.23697
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