Increased Risk of Death in Patients With Dementia Found Related to Common Hospice Medications

New analysis shows hospice patients with Alzheimer disease and related dementia who were taking a benzodiazepine or antipsychotic were 41% and 16%, respectively, more likely to die than patients not receiving these medications, within 6 months of hospice enrollment.

The study used data from national Medicare data sets, collected from 2014 to 2018 when nursing homes in the United States were required to report prescription records in hospice to Medicare. The data consisted of individuals in nursing homes long-term (ie, more than 100 days) with Alzheimer disease or related dementia who were newly enrolled in hospice. Alzheimer disease and related dementia was defined with ICD-10 criteria and codes on Medicare claims in the 6 months prior to hospice enrollment. Patients were not excluded if their primary reason for hospice enrollment was unrelated to dementia. Patients included in the analysis did not use benzodiazepine or antipsychotic in the 6-month pre-hospice baseline period. Patients who received benzodiazepines or antipsychotics only in the last 3 days of life or who were only enrolled in hospice for fewer than 3 days were excluded. Exposure to benzodiazepine or antipsychotic medication was considered as the first prescription fill of these medications after hospice enrollment. The comparison group comprised of patients who did not initiate use of the medications of interest during hospice.

After matching patient data on covariates, the benzodiazepine cohort consisted of 26,872 pairs (26,872 patients receiving the medication matched to 26,872 controls), and the antipsychotic cohort consisted of 10,240 matched pairs. Of all pairs, 13,219 were enrolled in hospice for a primary hospice-qualifying diagnosis of Alzheimer disease or related dementia, with 3685 enrolled for a diagnosis of stroke, and 3388 with a diagnosis of heart disease. The mean hospice stay length for patients with new benzodiazepine and antipsychotic use was 136.4 days and 154 days, respectively.

A greater proportion of patients who initiated benzodiazepine or antipsychotic use died by By 180 days (6 months) in hospice, as compared with their matched counterparts. Specifically, 73.58% of patients receiving benzodiazepines died by 180 days, vs 58.3% of those not receiving drugs of this type, and 70.7% of patients receiving antipsychotics died by 180 days, vs 63.3% of nonusers. Initiation of benzodiazepine use during hospice was found to be associated with a 41% higher hazard of death at 180 days compared with patients with no benzodiazepine use. Initiation of antipsychotics in hospice was associated with a 16% higher hazard of death compared with patients with no antipsychotic use at the 180 day mark.

“These early prescribing patterns suggest that these medications may sometimes be used as part of standard hospice care practices rather than fully tailored to each individual,” Lauren B. Gerlach, DO, MS, lead study author and geriatric psychiatrist, said in a press release. “For many patients, these medications can provide meaningful relief from distressing symptoms, but they also carry risks.”

“Our findings, highlight an opportunity for hospice teams to regularly reassess medication use, especially early in care, when maintaining communication and alertness may be prioritized by patients and families,” she added.

Gerlach also noted that the study findings indicate a need for stronger quality measures and prescribing guidance for clinicians working in dementia-specific hospice. Variations in prescription in hospice also require further research, particularly with this new evidence that incident benzodiazepine and antipsychotic use in hospice are linked to higher mortality.

References

1. Common hospice medications linked to higher risk of death in people with dementia. Press release. October 14, 2025. Accessed October 14, 2025. https://www.newswise.com/articles/common-hospice-medications-linked-to-higher-risk-of-death-in-people-with-dementia/?sc=mwhr&xy=5013482

2. Gerlach LB, Zhang L, Kim HM, et al. Benzodiazepine or antipsychotic use and mortality risk among patients with dementia in hospice care. JAMA Netw Open. 2025;8(10):e2537551