Antipsychotic Use in Assisted Living Varies Widely from State to State

April 11, 2023

April 11, 2023

Contact: Ellen Mullally

Over two-thirds of assisted living (AL) residents have some cognitive impairment, from a mild form up to dementia. While there is an increasing focus on nonpharmacologic treatments for resident behavioral challenges, antipsychotics are sometimes used to address these issues. A new study in the April issue of JAMDA found there is a significant variation from state to state in the prescribing of these drugs in the AL population.

In State Variation in Antipsychotic Use Among Assisted Living Residents with Dementia, the authors studied a 20% sample from 2017 national Medicare data, focusing on Medicare beneficiaries with dementia aged 65 and older who lived in AL. They found that the rate of antipsychotics prescribed in this population varied significantly by state, with a low of 7.8% for Hawaii to a high of 20.5% for Wyoming. Most states had an average rate of between 10% and 15%.

The authors observed, “The variation in antipsychotic exposure may be a function of variability in state regulations that impact antipsychotic use in AL.” They added that the variability they observed also could be a function of local practice patterns. However, they noted, “Prior work has not found a relationship between antipsychotic use in local ALs and nursing homes, nor do these rates in AL correspond to state rankings in antipsychotic use among nursing home residents during the same time period.”

The authors concluded, “Our study provides new insights into state variation in the prescribing of antipsychotics among AL residents with dementia using national data.” They added that while black box warnings suggest antipsychotics should not be prescribed for older adults with dementia, there “may be circumstances during which their prescribing is clinically appropriate.” They advised further research to determine how variations in the use of antipsychotics may relate to health outcomes for AL residents with dementia.

This study was conducted by researchers at the Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI;  Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI; Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Psychiatry, University of Michigan, Ann Arbor, MI; and Department of Internal Medicine, University of Michigan, Ann Arbor, MI.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editors for an interview, please email





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.


About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.