Dementia Patients in Hospice Care Face Higher Risk of Death with Benzodiazepine and Antipsychotic Use

A study published in JAMA Network Open reveals that patients with dementia in hospice care who start taking benzodiazepines or antipsychotics are more likely to die within six months than similar patients who do not receive these medications. The study analyzed national Medicare data from 2014 to 2018 and found that nearly half of the patients with dementia received a new benzodiazepine prescription, while 13% received an antipsychotic after hospice enrollment. The research highlights the need for better transparency in prescribing data and support for hospice clinicians to make more evidence-informed decisions about caring for patients with dementia at the end of life.

Key Takeaways:

• The study analyzed national Medicare data from 2014 to 2018 and found that nearly 139,000 nursing home residents with Alzheimer's disease and related dementias enrolled in hospice were at risk of increased mortality due to benzodiazepine and antipsychotic use.
• Patients who began taking benzodiazepines or antipsychotics after enrollment were 41% and 16% more likely to die within six months, respectively.
• Despite the six-month limit on Medicare hospice eligibility, about 20% of hospice patients with dementia live longer than six months and are discharged from hospice, losing access to supportive services they still need.
• Benzodiazepines and antipsychotics have well-established risks in older adults, including confusion, sedation, and falls, and are not tracked by hospice, leaving a gap in evaluating prescribing quality and reporting.
• The study's authors recommend that hospice teams regularly reassess medication use, especially early in care, to prioritize maintaining communication and alertness for patients and families.
• The findings highlight the need for dementia-specific hospice quality measures and prescribing guidance, as well as better transparency in prescribing data and support for hospice clinicians.

Statistics:

• 41% increase in mortality risk for patients with dementia who began taking benzodiazepines after enrollment in hospice.
• 16% increase in mortality risk for patients with dementia who began taking antipsychotics after enrollment in hospice.
• 48% of patients with dementia received a new benzodiazepine prescription after hospice enrollment.
• 13% of patients with dementia received an antipsychotic after hospice enrollment.
• The average hospice stay was more than 130 days, indicating that most patients were not in the final days or weeks of life.

Sources:

• Lauren B. Gerlach, DO, MS, et al. "Benzodiazepine or Antipsychotic Use and Mortality Risk Among Patients With Dementia in Hospice Care," JAMA Network Open, doi:10.1001/jamanetworkopen.2025.37551.
• University of Michigan.
• National Institute on Aging of the National Institutes of Health (K23AG066864, R01AG087073).
• Centers for Medicare and Medicaid Services Care Compare Tool.