Dementia Care: Results from CMS Initiative Show Drop in Antipsychotic Use, But Did Quality Improve?

​The Centers for Medicare and Medicaid Services launched the National Partnership to Improve Dementia Care in Nursing Homes in 2012 in an effort to improve quality of care for residents with dementia by reducing the high rates of prescribing antipsychotic medications and offering alternative treatments. However, results from the partnership showed that although the rate of antipsychotic use (excluding patients with schizophrenia, Tourette syndrome, or Huntington disease) did decrease by 34% between 2011 and July 2017, the overall rate of psychotropic use was unchanged and the use of mood stabilizers increased, according to an article published in JAMA Internal Medicine on March 17, 2018. Although there is no "high-quality evidence of efficacy" for treating symptoms of dementia with mood stabilizers or benzodiazepines, they have been used off-label for symptom management. However, mood stabilizers are associated with numerous adverse effects in vulnerable adults that potentially outweigh any benefit, especially given the lack of evidence supporting their efficacy.