# Prescribing without a guide: A national study of psychotropic and opioid polypharmacy among persons living with dementia

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2022 · $572,572

## Abstract

PROJECT ABSTRACT
The U.S. health care system is poorly equipped to deal with the growing number of persons living with
dementia (PLWD) in the U.S. and their complex medical and psychosocial needs. While memory
impairment is the cardinal feature of Alzheimer’s disease and related dementias (ADRD), behavioral
and psychological symptoms (e.g., apathy, delusions, agitation) are common during all stages of illness
and cause significant caregiver distress. Despite limited high-quality evidence of efficacy for
pharmacological treatment, our work has shown that clinicians prescribe psychotropic medications to
community-dwelling PLWD at rates that far exceed use in the general older adult population.
Unfortunately, this includes a high burden of psychotropic and opioid (central nervous system [CNS]-
active) polypharmacy (i.e., overlapping use of ≥3 medications from among antidepressants,
antipsychotics, antiepileptics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist
hypnotics, or opioids)— which is considered potentially inappropriate for older adults given serious
associated risks including fall-related injury, impaired cognition, and respiratory suppression or death
when involving opioids. Goal C-1 of the NIA’s Strategic Directions for Research highlights the need to
improve safe use of medications for older adults, while the NIA ADRD Milestone 8.A Summit noted “a
research and policy vacuum for interventions specifically aimed at improving life for persons with
ADRD.” Minimizing CNS polypharmacy is a critical opportunity to improve safe medication use for
PLWD, both through preventing new CNS polyRx and deprescribing—i.e., identifying and discontinuing
drugs [where] existing or potential harms outweigh existing or potential benefits—among PLWD already
exposed. However, the design of interventions to reduce CNS polypharmacy cannot proceed without
understanding why clinicians decide to prescribe these medications. In this explanatory mixed methods
study, we will first characterize patient characteristics associated with incident and continued CNS
polyRx in a unique cohort of all community-dwelling Medicare beneficiaries living with dementia in the
U.S., combining both traditional and managed Medicare. We will use these Medicare data to profile the
CNS prescribing of the clinicians that care for these PLWD, and then, through a national survey and
detailed follow-up qualitative interviews, we will characterize the prescribing decision-making process,
including the underlying knowledge, norms, facilitators, and barriers associated with prescribing intent.
Finally, with input from a multidisciplinary Expert Panel including a PLWD-caregiver dyad, we will
identify critical remaining knowledge gaps and possible intervention targets. With the new insights
gained, we will chart a way forward to address the critical but previously underrecognized challenge of
potentially inappropriate CNS polypharmacy among PLWD living in the community.

## Key facts

- **NIH application ID:** 10337351
- **Project number:** 1R01AG074957-01
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** DONOVAN T MAUST
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $572,572
- **Award type:** 1
- **Project period:** 2022-04-15 → 2026-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10337351

## Citation

> US National Institutes of Health, RePORTER application 10337351, Prescribing without a guide: A national study of psychotropic and opioid polypharmacy among persons living with dementia (1R01AG074957-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10337351. Licensed CC0.

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