An analysis by the United States Government Accountability Office (GAO) has found that about 1/3 of older adults with dementia who resided >100 days in a nursing home in 2012 were prescribed an antipsychotic. For those with dementia living outside of a nursing home, about 14% were prescribed an antipsychotic, according to data from the Medicare Part D program. 

Concerns have been raised about the use of antipsychotic drugs to address the behavioral symptoms of dementia, primarily due to the FDA’s boxed warning that these drugs may cause an increased risk of death when used by older adults with dementia and the drugs are not approved for this use. GAO was asked to examine psychotropic drug prescribing for older adult nursing home residents. For the analysis, GAO aimed to study:

  • to what extent antipsychotics are prescribed for older adults with dementia living inside and outside nursing homes
  • what is known from selected experts and published research about factors contributing to such prescribing
  • to what extent HHS has taken to reduce the use of antipsychotic drugs by older adults with dementia

Patient agitation, delusions, and other setting-specific characteristics were identified as contributing factors in antipsychotic prescribing. Schizophrenia or bipolar disorder diagnoses were excluded from the analysis due to existing FDA-approved antipsychotics for these conditions. Experts reported that antipsychotic drugs were often started in hospital settings and continued in nursing homes. Moreover, low levels of nursing home staff lead to higher antipsychotic drug use. 

RELATED: Antipsychotic Drug Therapy Often Related to Unapproved Uses

Currently, no agencies within the Department of Health and Human Services (HHS) have tackled antipsychotic drug use among older adults in non-nursing home settings, such as assisted living facilities or individuals’ homes. The HHS’s National Alzheimer’s Plan does address improved dementia care for all individuals, but not much focus has been set on settings outside nursing homes. 

In its report, GAO recommended that the HHS update the National Alzheimer’s Plan to include growth of outreach and educational efforts at reducing antipsychotic drug use among older adults with dementia to include those in non-nursing home settings.

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