Exposure to Potentially Inappropriate CNS Drugs Falls from 39.3% to 29.3% Among Older Adults with Cognitive Disorders

Researchers applied the American Geriatrics Society Beers Criteria to identify CNS-active drugs including benzodiazepines, Z-drugs, and antipsychotics, then compared outcomes between exposed and unexposed participants. Exposed individuals experienced higher rates of emergency visits, prolonged hospitalizations, and mortality. The 10-percentage-point absolute reduction equates to roughly 3 million fewer exposed older Americans by 2022, yet one-third of the 29.7 million represented population remained at risk. The study did not examine mechanisms behind the decline, but the trend aligns with increased clinician awareness following the 2012 and 2019 Beers Criteria updates and the 2009 Team Alice case that catalyzed University at Buffalo deprescribing initiatives. Observational design precludes causal inference; unmeasured confounding by changing dementia severity or concurrent non-pharmacologic interventions could contribute. Connections to pharmacist-led reviews and home-care coordination were noted but not quantified. Next steps require pragmatic cluster-randomized trials testing pharmacist-nurse-primary care bundles against usual care, with primary endpoints of injurious falls and all-cause hospitalization rather than surrogate adherence metrics. Registries linking prescribing data to outcomes at the patient level would clarify whether further reductions below 20% exposure are achievable by 2028.