To examine the clinical settings of medication initiation and the continuation rates of medications affecting cognition, specifically benzodiazepines, nonbenzodiazepine hypnotics, antipsychotics, and anticholinergics, in elderly patients.
Approach:
Key Findings:
4955 new medication initiations representing 23.4 million first prescriptions among Medicare beneficiaries, highlighting the scale of the issue.
Patients with dementia initiating antipsychotics were more likely to have been in acute or postacute settings before initiation, indicating a critical point for intervention.
67.1% of patients with dementia continued antipsychotic medication one year later, suggesting a need for monitoring and review.
Higher continuation rates were observed across all cognitive statuses for medications affecting cognition, raising concerns about long-term use.
Interpretation:
A significant proportion of older adults initiate medications affecting cognition from acute or postacute settings, and many continue these medications long-term, indicating a need for targeted interventions to improve patient outcomes.
Limitations:
Assumption that the last clinical setting before medication initiation was the source of the prescription, which may not accurately reflect prescribing practices.
Conclusion:
Efforts to reduce prescriptions of cognition-affecting medications should focus on acute or postacute settings to improve patient outcomes.
