# Medicating distress: Use of psychotropic medications among patients with dementia receiving hospice care

> **NIH NIH K23** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2021 · $196,560

## Abstract

ABSTRACT
The goal of this Mentored Career Development Award is to prepare Dr. Lauren Gerlach for a career as an
independent investigator focused on measuring and improving the quality of end-of-life care for older adults
with psychiatric disorders and dementia. Dr. Gerlach’s long-term career goal is to establish herself as an
independent investigator in geriatric mental health services and mixed methods research. Behavioral
symptoms in advanced dementia are common, and despite limited evidence to support their use, the mainstay
of such symptom management in hospice is off-label use of psychotropic medications such as antipsychotics.
However, recent clinical trial evidence suggests that use of antipsychotics at end of life may be associated with
worse outcomes for patients—raising concerns that the very medications prescribed to alleviate distress in fact
exacerbate it. Little is known about how widely psychotropics are prescribed during end-of-life care for
dementia, the factors that influence this prescribing, or the outcomes of such use. These critical knowledge
gaps—including which patients are at greatest risk of potential harm—limit the ability to develop a consensus
on best practices to address distressing behavioral symptoms in hospice care for dementia. Dr. Gerlach’s
clinical training as a geriatric psychiatrist and prior research in pharmacoepidemiology provide the critical
foundation for this work, but her transition to independence requires new skills and knowledge that will be
gained through a coordinated program of research, mentorship, and coursework during the 5-year award
period. This will include training in: 1) hospice-based dementia care, 2) use of Medicare and Minimum Data Set
(MDS) data to examine end-of-life care, 3) advanced statistical methods for pharmacoepidemiology research,
and 4) qualitative research methods. The proposed study will use Medicare data for all older adults with
dementia enrolled in hospice in 2015 to determine the array of patient, provider, and hospice characteristics
that influence psychotropic prescribing (Aim 1). In partnership with a local hospice organization, an exploratory
sub-aim will examine the indications for psychotropic prescribing at end of life—information not available in
claims data. Aim 2 will use linked Medicare and MDS data to examine outcomes associated with psychotropic
prescribing (e.g., functional impairment, behavioral symptoms, mortality). Finally, Aim 3 will include interviews
with patients with early-stage dementia, caregivers, and hospice providers to elicit stakeholder perspectives on
the goals of hospice care. Study findings will inform how to best manage behavioral symptoms at the end of
life. Given that not all patients with dementia utilize hospice, this K23 is designed to lay the foundation for a
subsequent R01 to examine broader end-of-life care among all patients with dementia and to determine how
hospice enrollment impacts outcomes. The R01 study will use Medicare ...

## Key facts

- **NIH application ID:** 10122511
- **Project number:** 1K23AG066864-01A1
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Lauren Beth Gerlach
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $196,560
- **Award type:** 1
- **Project period:** 2021-01-01 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10122511

## Citation

> US National Institutes of Health, RePORTER application 10122511, Medicating distress: Use of psychotropic medications among patients with dementia receiving hospice care (1K23AG066864-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10122511. Licensed CC0.

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