Off-Label Antipsychotic Use in Older Adults with Dementia: Not Just a Nursing Home Problem

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®

This is the title of a report issued today by the AARP Public Policy Institute.  The data in this report includes individuals living in Assisted Living communities and certainly merits reading and action by AL leadership and clinicians.

“Antipsychotic (AP) drugs are often prescribed “off-label” to dementia patients to treat behavioral symptoms of the disease, putting them at increased risk of health events such as stroke and death. While efforts to reduce AP use among dementia patients living in nursing homes are showing some success, less attention is given to older adults living in the community.

The AARP Public Policy Institute recently analyzed insurance claims data and found that rates of AP use among older adults with dementia who live in the community increased by 6%, from 12.6% to 13.4%, between 2012 and 2015. During this same time period antipsychotic use reportedly dropped by 34% among nursing home residents with dementia.

Efforts to reduce the off-label use of antipsychotic drugs among elderly people with dementia should be expanded beyond nursing homes. This is especially important since many nursing home residents begin antipsychotic drugs prior to their arrival at the facility.”


Antipsychotic use was highest among women living in the South or Midwest and people 75 years or age or older in the AARP report as well as results provided by GAO (Government Accounting Office) and CMS.

Assisted Living communities can take advantage of an Antipsychotics webpage, which includes consumer resources, provided by the National Center for Assisted Living (NCAL) to evaluate and reduce the use of antipsychotic medications.