Summary: New UCLA research finds that initial prescriptions for medications that can impair cognition—such as antipsychotics and benzodiazepines—are disproportionately started in acute and post-acute care settings (emergency departments, hospitals, and skilled nursing facilities) rather than in outpatient doctors’ offices. The study highlights that older adults with dementia are especially likely to receive these prescriptions in high-stress clinical environments and that many of these prescriptions persist long term.
Key Facts
- Disproportionate starts: Although only 22% of visits for people with dementia occur in acute or post-acute settings, 43% of antipsychotic prescriptions for that group were initiated there.
- Persistent use: Prescriptions started in these settings are often continued: about 51% of dementia patients who began a cognition-affecting medication in a hospital or similar setting remained on it one year later.
- Highest-risk groups: People with dementia or cognitive impairment not dementia (CIND) are the most likely to be started on these drugs, despite elevated risks of falls, delirium, and rehospitalization.
- Documentation gaps: This study builds on earlier UCLA findings that up to 70% of central nervous system–active medication prescriptions lacked a documented clinical indication.
- Action points: Researchers recommend targeting “care transitions”—discharge moments from hospitals or nursing facilities—for interventions to reduce unnecessary prescribing.
Source: UCLA
Overview: Medications that affect cognition are commonly prescribed to older adults, yet they carry risks such as increased delirium and greater fall risk. This analysis examines where these medications are most often first prescribed and how often patients remain on them a year after initiation.
Lead author Dr. Dan Ly, an assistant professor of medicine at UCLA’s David Geffen School of Medicine and the VA Greater Los Angeles, emphasizes that antipsychotics and benzodiazepines can worsen cognitive function and raise the likelihood of falls and confusion in older patients. The research shows these prescriptions frequently originate in time-pressured, high-acuity environments where clinicians may prioritize immediate safety over long-term medication planning.
The study used data from the Health and Retirement Study (HRS) linked to Medicare fee-for-service claims for adults aged 66 and older from Jan. 1, 2008, through Dec. 31, 2021. Researchers examined four classes of medications known to affect cognition: benzodiazepines, nonbenzodiazepine hypnotics, antipsychotics, and anticholinergics. They categorized prescription initiation settings as acute/post-acute (emergency rooms, hospitals, and skilled nursing facilities) versus outpatient doctors’ offices, and grouped patients by cognitive status: no impairment, cognitive impairment not dementia (CIND), and dementia.
Key numeric findings include: 14% of patients with no cognitive impairment, 17% of those with CIND, and 22% of people with dementia received a new cognition-affecting medication in an acute or post-acute setting. One year later, ongoing use was observed in 38% of those without impairment, 44% of those with CIND, and 51% of those with dementia who had been started on these medications.
The investigators observed that prescriptions for drugs affecting cognition were initiated in acute and post-acute settings at rates higher than the share of visits those settings represented—supporting the conclusion that such environments are key contributors to initiation. For example, 43% of antipsychotic starts for patients with dementia occurred in acute/post-acute settings, even though only 22% of their visits were in those settings.
Dr. Ly noted the tendency for “temporary” medications started during crises—such as severe agitation or sundowning—to become long-term treatments without clear plans for discontinuation. The study’s limitations include the assumption that the last recorded clinical setting was where the prescription was started; further research will examine prescribing provider characteristics to better tailor interventions.
Key Questions Answered
A: Acute care teams often address urgent behavioral crises or severe agitation in patients with dementia. Antipsychotics or sedatives are sometimes used to stabilize the situation quickly. However, these crisis-driven prescriptions can become permanent if there is no plan for reassessment or discontinuation.
A: Beyond cognitive dulling or “brain fog,” antipsychotics and benzodiazepines increase fall risk by impairing balance and reaction time, which can lead to fractures and head injuries. They can also precipitate or worsen delirium and raise the risk of readmission to the hospital.
A: Families should request a medication reconciliation at discharge and ask clear questions: Which medications are new? Why were they started? Is there a documented plan and target date for stopping them? These steps help ensure that temporary treatments are reviewed and discontinued when appropriate.
Study authors, funding and publication
The study was authored by Dan P. Ly, Annie W. Yang, Mei Leng, Catherine Sarkisian, Cheryl L. Damberg, and John N. Mafi, and will appear in JAMA Network Open. Funding sources included multiple awards from the National Institute on Aging, the National Institutes of Health, the U.S. Department of Veterans Affairs, and the UCLA Clinical and Translational Science Institute. The authors report prior work showing many prescriptions for central nervous system–active medications lacked documented clinical indications, underscoring the need to curb risky overprescribing.
Editorial Notes
- This summary was edited by a Neuroscience News editor.
- The journal paper was reviewed in full by the editorial team.
- Additional context and practical implications were added by staff to clarify care recommendations for families and clinicians.
About this neurology and neuropharmacology research news
Author: Enrique Rivero
Source: UCLA
Contact: Enrique Rivero – UCLA
Image: The image is credited to Neuroscience News
Original Research: Open access. “Initiation Setting and Persistence of Medications Affecting Cognition in Older Adults” by Dan P. Ly et al., JAMA Network Open. DOI:10.1001/jamanetworkopen.2026.10234
Abstract
Initiation Setting and Persistence of Medications Affecting Cognition in Older Adults
Medications that negatively affect cognition—such as antipsychotics, benzodiazepines, nonbenzodiazepine hypnotics, and anticholinergics—may raise risks of delirium and falls among older adults, yet they are still frequently prescribed. This study analyzed where these medications are first prescribed and how often patients continue them one year later, identifying acute and post-acute care settings as key targets for interventions to reduce potentially harmful long-term use.