JAMA Netw Open

Benzodiazepine and antipsychotic use in hospice dementia care linked to increased mortality

October 16, 2025

Study details: This retrospective cohort study evaluated >139,000 Medicare beneficiaries with Alzheimer’s disease and related dementias newly enrolled in hospice care between 2014 and 2018. Patients with no benzodiazepine or antipsychotic use in the prior six months were included. Incident users were matched 1:1 to nonusers based on demographics, clinical status, and baseline CNS medication use. Primary outcome: all-cause mortality within 180 days of hospice enrollment.

Results: Initiation of benzodiazepines was associated with a 41% increased risk of 180-day mortality (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.38–1.44). Antipsychotic initiation was associated with a 16% increased risk (HR 1.16; 95% CI, 1.12–1.20). The associations persisted across sensitivity analyses and with greater cumulative exposure.

Clinical impact: These findings underscore the need for cautious prescribing in hospice dementia care. While symptom management is essential, benzodiazepines and antipsychotics may confer substantial mortality risk. Development of dementia-specific hospice prescribing guidelines is warranted to support safer, individualized care.

Source:

Gerlach LB, et al. (2025, October 14). JAMA Netw Open. Benzodiazepine or Antipsychotic Use and Mortality Risk Among Patients With Dementia in Hospice Care. https://pubmed.ncbi.nlm.nih.gov/41085983/