Nursing home residents with dementia are far more likely to be taking five or more prescription drugs at once than their peers without the condition — and while the problem has improved over the past decade, researchers say there’s still a long way to go.
A new study published in Alzheimer’s Research & Therapy found that 56.2% of dementia patients experienced polypharmacy — defined as using five or more different prescription drugs simultaneously — compared to just 35.6% of older adults without dementia. The findings, drawn from data on more than 1.18 million adults aged 65 and older, raise fresh concerns about medication management in long-term care settings.
A Stubborn Gap Between Patients With and Without Dementia
The study looked at national health registry data from 2022 and tracked both standard polypharmacy and a more specific measure: CNS-active polypharmacy, which involves taking three or more drugs that affect the central nervous system at the same time. That figure hit 10.1% among dementia patients — more than four times the 2.3% rate seen in those without dementia.
Of the total population studied, about 38,252 individuals — roughly 3.2% — had a dementia diagnosis. The heavy medication burden on that group reflects both the complexity of managing dementia alongside other chronic conditions and the challenges clinicians face when trying to reduce prescription loads without destabilizing fragile patients.
Progress Made — But Not Enough
The study did bring one encouraging finding: polypharmacy rates among dementia patients dropped by nearly nine percentage points between 2012 and 2022, falling from 65.1% to 56.2%. That trend suggests growing awareness of the risks tied to overmedication — including falls, confusion, and adverse drug interactions — has started to shift prescribing habits.
Still, the study’s authors were clear that the current numbers aren’t good enough. They called for dementia-specific treatment guidelines that incorporate both medication-based and non-drug approaches to care, and stressed the need for safer prescribing that takes patients’ full list of conditions and medications into account.
“Nonetheless, the prevalence of polypharmacy remains substantially higher in dementia,” the authors wrote. “The findings highlight the continued need for safer prescribing practices taking morbidities and associated medication risks into account.”
What This Means for Skilled Nursing Facilities
For nursing home operators and clinical teams, the findings are a useful benchmark. Skilled nursing facilities already face scrutiny over unnecessary medications — it’s a standard area of CMS survey review — but studies like this one underscore why medication reconciliation and deprescribing conversations need to be built into routine dementia care, not treated as an afterthought.
Industry reports have increasingly flagged CNS-active polypharmacy as a safety concern, particularly because of its links to sedation, fall risk, and cognitive decline in older residents. The combination of antipsychotics, antidepressants, sleep aids, and other CNS medications remains common in memory care units, even as regulators and advocacy groups push for reduction.
The study’s authors stopped short of recommending specific protocols, but they were direct in their conclusion: developing clearer, dementia-focused prescribing standards is overdue, and real progress will require action at both the clinical and institutional levels.
