Overview
- Researchers linked Health and Retirement Study data to Medicare fee-for-service claims from 2013–2021 to track five CNS-active drug classes.
- Overall prescribing among fee-for-service beneficiaries fell from about 20% in 2013 to 16% in 2021, driven by declines in benzodiazepines and non-benzodiazepine hypnotics, with a small rise in antipsychotics and stable anticholinergic antidepressant use.
- Use was higher with worsening cognition: 17% for older adults with normal cognition, nearly 22% for those with cognitive impairment without dementia, and about 25% for those with dementia.
- By 2021, over two-thirds of recipients had no documented indication, while clinically justified prescriptions dipped from 6.0% to 5.5% and likely inappropriate use fell from 15.7% to 11.4%.
- Authors recommend clinician–caregiver medication reviews, alternatives, and tapering when appropriate, noting limitations such as the exclusion of Medicare Advantage data and potential underdocumentation of symptoms.