Benzodiazepines, Antipsychotics Linked to Increased Death in Dementia Hospice: Daily Dose

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On October 15, 2025, we reported on findings from a study published in the JAMA Network Open that assessed the association between incident benzodiazepine or antipsychotic use and 180-day mortality among nursing home residents with Alzheimer disease and related dementias (ADRD) enrolled in hospice.

The study

Researchers analyzed Medicare claims and Minimum Data Set assessments from July 1, 2014, through September 30, 2018, examining 139 103 long-term nursing home residents with ADRD newly enrolled in hospice. The cohort was 75.8% women with a mean age of 87.6 years. Participants had no benzodiazepine or antipsychotic use in the 6 months prior to hospice enrollment.

Using 1:1 matching, investigators created 2 cohorts: 26 872 matched pairs for benzodiazepine analysis and 10 240 matched pairs for antipsychotic analysis. Matching criteria included enrollment timing, age, sex, comorbidity burden, cognitive function, and baseline central nervous system medication use.

The findings

Initiation of benzodiazepine use was associated with higher 180-day mortality compared with nonuse (HR, 1.41; 95% CI, 1.38-1.44), as was initiation of antipsychotic use (HR, 1.16; 95% CI, 1.12-1.20), according to the results.

The associations persisted across multiple sensitivity analyses. Propensity score–weighted models showed even stronger associations (benzodiazepine HR, 1.92; 95% CI, 1.88-1.96; antipsychotic HR, 1.86; 95% CI, 1.79-1.94).

Authors' comments

"These findings suggest that clinicians should carefully weigh the risks and benefits of initiating benzodiazepine and antipsychotic use for individuals with ADRD in hospice, given the potential association with increased mortality."

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