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- Antipsychotic drugs are being prescribed to seniors far more often, with use in adults 65+ rising more than 50% in less than a decade.
- Many seniors stay on these drugs long-term, even though the FDA warns they increase the risk of death in older adults with dementia.
- Most of these prescriptions aren’t for schizophrenia or severe mental illness, but to control dementia-related behaviors like agitation, wandering, or shouting.
- Fewer psychiatrists are involved, while more prescriptions are coming from long-term care settings, where time and staffing are limited.
- Safer, non-drug approaches exist, but they take training, time, and staff—resources many facilities simply don’t have.
When an older adult with dementia starts wandering the halls at night, shouting, or becoming aggressive, the situation can feel urgent and overwhelming.
Families worry about safety. Caregivers worry about control. Facilities worry about disruption.
And increasingly, the response is medication—specifically, antipsychotic drugs that sedate behavior but carry serious risks for seniors.
A new research letter published in JAMA Psychiatry by researchers from Rutgers University-New Brunswick and Columbia University shows just how sharply use of these medications has risen among older Americans—even though they do little to help dementia and are known to increase the risk of death.
A sharp rise in risky prescriptions
Using a national prescription-claims database that captures more than 90% of U.S. retail pharmacy fills, researchers tracked antipsychotic use among adults 65 and older from 2015 through 2024.
What they found was striking:
- Overall antipsychotic use rose nearly 52%, from 2.67 to 4.05 per 100 older adults
- Long-term use (120 days or more per year) increased 65%
- Among adults 75 and older, use climbed from 3.42 to 5.12 per 100
That growth matters because antipsychotics carry an FDA black-box warning stating they increase the risk of death in older patients with dementia.
“The evidence is pretty solid on the risks,” said Stephen Crystal, co-author of the study and director of the Center for Health Services Research at Rutgers.
Those risks include falls, fractures, strokes, blood clots, heart events, and death—especially in frail seniors.
Why dementia is at the center of concern
The claims data don’t show why each prescription was written. Antipsychotics remain essential for some conditions, such as schizophrenia or bipolar disorder with psychosis.
But Crystal said those illnesses are not common enough in older adults to explain the surge.
“We think that conditions like schizophrenia that have FDA-approved indications for antipsychotic treatment are unlikely to account for the majority of the rates of use that we observed,” he said.
Instead, researchers point to the behavioral and psychological symptoms of dementia—agitation, wandering, shouting, hallucinations—as the main driver.
In many cases, the drugs are used to “damp down” behavior that is distressing to caregivers or disruptive to facilities. The sedation can reduce roaming and acting out—but at a steep cost.
“These drugs can be highly sedating,” Crystal said, “and that increases fall risk and reduces physical activity.”
Fewer psychiatrists, more institutional prescribing
The study also found a shift in who is managing these medications.
Between 2015 and 2024:
- The share of patients with at least one antipsychotic prescribed by a psychiatrist fell from 30% to 20%
- Prescriptions filled through long-term care pharmacies rose from 14% to 21%
That matters because careful evaluation is often the first step in treating dementia-related behaviors.
Symptoms can be worsened—or even caused—by infections, medication interactions, unmanaged pain, or depression. Addressing those issues takes time, staffing, and training.
“This can look like managing symptoms,” Crystal said. “It’s so much easier to write a prescription than do the work of addressing the underlying condition—especially in nursing homes and assisted living facilities that are dangerously short-staffed.”
A small bright spot—and a warning for families
There was one encouraging sign: use of older, first-generation antipsychotics—linked to even higher mortality—fell from 22% to 14%.
Still, the overall rise suggests a system leaning more heavily on medication to solve problems that are often social, environmental, or staffing-related.
The study’s lead author, Mark Olfson of Columbia University, said families should ask pointed questions when a loved one is prescribed an antipsychotic.
What problem is the drug meant to address?
What other approaches were tried first?
Is there a plan to reassess, taper, and stop the medication once a crisis passes?
“These are high-stakes decisions,” Olfson said.
Disclaimer: This article is for informational purposes only and does not provide medical advice. Decisions about medications should always be made with a qualified health care professional who knows the patient’s full medical history.
