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

> **NIH NIH K23** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $75,600

## 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. 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 and linked survey data to determine factors that impact
the care patients receive in the last year of life and to identify the extent of potentially ina...

## Key facts

- **NIH application ID:** 11061540
- **Project number:** 3K23AG066864-04S1
- **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:** 2024
- **Award amount:** $75,600
- **Award type:** 3
- **Project period:** 2021-01-01 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11061540

## Citation

> US National Institutes of Health, RePORTER application 11061540, Medicating distress: Use of psychotropic medications among patients with dementia receiving hospice care (3K23AG066864-04S1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/11061540. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*