Findings highlight the importance of medication review and follow-up, particularly across transitions of care. 

Medications may be started to address an immediate clinical need, but for older adults with dementia, treatment can continue long after that initial episode has passed. 

A new study published in JAMA Network found that 51.2% of older adults with dementia who started cognition-affecting medication were still taking a medication in the same class one year later. Among those who started an antipsychotic, that figure rose to 67.1%. 

For long-term and senior care teams, the findings underscore the importance of medication reconciliation, clear documentation, and ongoing review—especially following a transition in care. 

What the Study Found 

Researchers analyzed data from community-dwelling adults age 66 and older, focusing on benzodiazepines, nonbenzodiazepine hypnotics, antipsychotics, and anticholinergics. 

Older adults with dementia were more likely to have these new prescriptions associated with an acute or post-acute care setting, with the pattern particularly pronounced for antipsychotics. 

The researchers noted that the prescribing setting was inferred from the participant’s last clinical setting before the first prescription fill, so the findings show an association rather than confirming where medications were initiated.  

The Importance of Ongoing Medication Review 

Antipsychotics, benzodiazepines, and other cognition-affecting medications can carry important risks for older adults, making ongoing evaluation essential. 

Transitions of care are a particularly important time for review. Following a hospitalization, emergency department visit or other change in care setting, teams should understand why a medication was started, whether it was intended for short- or long-term use, and when it should be reassessed. 

Key questions include: 

• Is the original indication clearly documented? 
• Is the medication still clinically appropriate? 
• Has the resident’s condition or care plan changed? 
• Are adverse effects or other medication-related concerns present? 
• Are nonpharmacologic interventions appropriate? 
• Is gradual dose reduction or deprescribing evaluation clinically appropriate? 
• Who is responsible for follow-up, and when should it occur? 

Medication decisions should be individualized and made in collaboration with the prescriber, consultant pharmacist, nursing team, resident, and family or responsible party, as appropriate. 

Make Transitions a Medication Checkpoint 

The findings highlight the importance of initiating reassessment of treatment as residents’ conditions and care needs change. 

Complete medication reconciliation, clear documentation, and timely pharmacist and prescriber review can help ensure medications remain appropriate and aligned with each resident’s plan of care.