Psychopharmacology
Antipsychotics Use May Worsen Behavior in Nursing Homes
Study highlights importance of non-pharmacological methods and interventions.
Posted December 27, 2024 Reviewed by Davia Sills
Key points
- With the aging population, there is an increased demand for nursing homes and assisted living facilities.
- Antipsychotic medications are increasingly being used off-label to treat undesirable symptoms of dementia.
- However, the drugs often result in unwanted behaviors getting worse; other treatments should be considered.

As the world’s population is aging, the number of residents living with dementia who require long-term care is expected to rise. A new study by researchers at the University of Waterloo demonstrates that antipsychotic medications significantly worsened behavior in nursing home residents.
“The proportion of long-term care (LTC) residents being treated with antipsychotic medication is high, and these medications may exacerbate behavioral symptoms,” wrote University of Waterloo corresponding author Daniel Leme, Ph.D., in collaboration with Krista Mathias, Ph.D., Amanda Mofina, Ph.D., Rosa Liperoti, M.D., Gustavo Betini, Ph.D., and John Hirdes, Ph.D.
The population globally is getting older. By 2050, the number of people aged 65 years or older will be more than double the number of children under the age of 5 years and equal to the number of children less than 12 years old, according to the World Population Prospects 2022 Summary of Results by the United Nations.
With the increase in the number of people aged 65 years or older comes an expected increase in demand for nursing homes. The market size for long-term care is USD 1.2 trillion in 2024 and is expected to reach USD 2.1 trillion by 2034 with a compound annual growth rate of 6.2 percent during 2025-2034, according to Global Market Insights.
There are 1.2 million Americans living in nursing homes in the United States in 2024, according to Statista. Nursing homes, also known as skilled nursing facilities or long-term care facilities, assist seniors with debilitating physical and/or mental health conditions that require 24-hour skilled nursing supervision and personal care.
Nearly half (48 percent) of nursing home residents have Alzheimer’s disease or other forms of dementia, according to the Alzheimer’s Association 2020 Alzheimer’s Disease Facts and Figures report. Alzheimer’s disease comprises 60 percent to 80 percent of dementia cases, according to the Alzheimer’s Association. Other forms of dementia include vascular dementia, dementia with Lewy bodies, frontotemporal dementia, and Parkinson’s disease dementia. An estimated 50 million people worldwide are living with dementia, of which 7.9 million are Americans, according to Recent Global Trends in the Prevalence and Incidence of Dementia, and Survival With Dementia by Prince et al.
The behavioral and psychiatric symptoms of dementia patients outside of cognitive impairments, also known as noncognitive neuropsychiatric symptoms (NPS), include anxiety, depression, aggression, agitations, delusions, hallucinations, disinhibition, and apathy, according to Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations From a Multidisciplinary Expert Panel by Dr. Kales, M.D. et al. published in the Journal of the American Geriatrics Society.
“Antipsychotics are commonly used off-label as first-line agents for pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in long-term care (LTC) facilities,” the researchers wrote.
The symptoms of BPSD include anxiety, depression, repetitive questioning, refusal of care, wandering, aggression, sexually inappropriate behaviors, dysphoria, appetite changes, sleep changes, irritability, agitation, psychosis, delusions, and hallucinations, according to the University of Waterloo team.
“BPSDs are frequently experienced in LTC facilities and can be distressing for patients, difficult to manage for caregivers and staff, and can significantly affect the prognosis and management of dementia,” explained the researchers.
To conduct the current study, the University of Waterloo researchers analyzed data from over 494,000 nursing home residents, of which 26 percent were given antipsychotics for off-label use. The mean age of the study participants was 82.8 years old, with 64.4 percent female and 43.7 percent male.
According to the researchers, it is the first Canadian national longitudinal observational study that uses the statistical technique called propensity score matching and weighting to evaluate the effect of antipsychotics on nursing home residents.
The researchers concluded that antipsychotics caused an increase in the risk of behavior getting worse and that antipsychotics are “minimally effective for behavior change” for the nursing home residents studied. The researchers found that a majority (68 percent) of the nursing home residents on antipsychotics exhibited deterioration of behavior.
The University of Waterloo study highlights the importance of non-pharmacological methods and interventions, such as behavioral therapy, age-appropriate exercise, walking activities, functional exercises, social contact (real or simulated), art therapy, music therapy, and multisensory therapy.
“Our findings support the importance of focusing on non-pharmacological approaches to care, especially in the setting of those experiencing BPSD,” the researchers concluded.
Copyright © 2024 Cami Rosso. All rights reserved.