• Posted October 16, 2025

Common Hospice Meds Increase Death Risk For Alzheimer's, Dementia Patients

Hospice drugs commonly handed out to people with Alzheimer’s disease and dementia might be hastening their deaths, a new study says.

Benzodiazepines and antipsychotics given to hospice patients with dementia appear to increase their risk of earlier death, compared to similar patients who weren’t prescribed those drugs, researchers reported Oct. 14 in JAMA Network Open.

Dementia patients who began taking benzodiazepines were 41% more likely to die within six months, and those on antipsychotics 16% more likely to die, researchers found.

“Dementia is now the most common qualifying condition among hospice enrollees, yet many of these patients are not imminently dying,” said lead researcher Dr. Lauren Gerlach, a geriatric psychiatrist at the University of Michigan.

“Because prognosis in dementia is so difficult to determine, nearly 1 in 5 patients will outlive the six-month eligibility window for hospice,” she said in a news release. “This makes it critical that medications used during this period enhance, rather than diminish, quality of life.”

Hospice care was originally developed to help people dying from cancer, but has since expanded to ease the passing of people with other terminal diseases like dementia.

The proportion of hospice patients with Alzheimer’s disease or dementia has increased from less than 1% in 1995 to 25% in 2023, researchers said in background notes.

However, Alzheimer’s and dementia follow a more prolonged and unpredictable trajectory than cancer, making it uncertain that a patient in hospice will necessarily die soon.

In fact, 20% of those patients outlive the six-month prognosis required for hospice eligibility and will be discharged from the program, researchers said.

“The Medicare hospice benefit was designed when most patients enrolling had cancer and short, predictable trajectories,” Gerlach said. “For people with dementia, whose disease course can span years, we need care models and prescribing guidance that better reflect their experience.”

Benzodiazepines and antipsychotics are commonly prescribed to hospice patients to manage agitation, anxiety and delirium, researchers said. 

However, they also increase risks of falls, confusion and sedation, potentially affecting patients’ quality of life.

For the new study, researchers analyzed national Medicare data between July 2015 and September 2018, during a period when hospice facilities were required to report prescriptions.

None of the 139,000 Alzheimer’s or dementia patients had received either benzodiazepines or antipsychotics in the six months prior to entering hospice, researchers found.

Despite this, nearly half (48%) received a new benzodiazepine prescription and 13% an antipsychotic after hospice enrollment — most within days of admission, results showed.

The average hospice stay among these patients was more than 130 days, indicating that many patients were not in their final days or weeks of life.

Patients prescribed the drugs had a higher risk of dying in hospice than those who didn’t get them, researchers found.

“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,” Gerlach said.

“For many patients, these medications can provide meaningful relief from distressing symptoms, but they also carry risks,” she added. “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.”

Researchers also are concerned that there is little oversight of medication use in hospice.

Since 2018, hospice agencies have not been required to report prescribing data to the federal government, they noted.

“Right now, hospice prescribing is a black box,” Gerlach said. “Medications covered under the hospice benefit are not reported to Medicare, so we have almost no visibility into what patients are receiving. That makes it impossible to monitor prescribing safety or quality on a national level.”

Interestingly, benzodiazepine and antipsychotic prescriptions are tracked as part of nursing home quality reporting, but the same meds aren’t tracked for hospice, researchers said.

“We need better transparency in prescribing data and support for hospice clinicians to make more evidence informed, individualized decisions about how to best care for patients with dementia at end of life,” Gerlach said.

More information

The Alzheimer’s Association has more on hospice care.

SOURCES: University of Michigan, news release, Oct. 14, 2025; JAMA Network Open, Oct. 14, 2025