What Every Family Should Know About Psychotropic Medications in Elder Care

Let’s talk about something that families don’t always know to ask—but absolutely should.

If your loved one is in a nursing home, assisted living facility, or even the hospital, and they’ve recently been prescribed something for “agitation,” “anxiety,” or “behavioral symptoms”… there’s a good chance it’s a psychotropic medication.

And while these medications can be helpful in certain cases, they also come with serious risks—especially for older adults.
As a consultant pharmacist, I review these prescriptions every day, and I’ve seen the good, the bad, and the very dangerous.

Psychotropic medications are drugs that affect mood, perception, and behavior. They include:

In elder care, they’re often prescribed for residents who are:

But here’s the catch: they are often used as a shortcut—to “quiet down” behavior that might actually have an underlying cause. And in elderly patients, these medications can cause far more harm than good.

The FDA has issued black box warnings about the use of antipsychotics in elderly patients with dementia. Why? Because they significantly increase the risk of:
🚨 Stroke
🚨 Heart attack
🚨 Falls and fractures
🚨 Sudden death

Beyond that, psychotropics can cause:

In other words, your loved one may appear calmer—but at what cost?

According to research published in The BMJ, antipsychotics are frequently used inappropriately in long-term care settings, often without a clear diagnosis or without proper documentation of risk-benefit analysis [1].

There are cases where psychotropic medications are clinically appropriate and necessary. For example:
✔️ A patient with schizophrenia or bipolar disorder who has been stable on medication
✔️ Severe depression not responsive to therapy
✔️ Hallucinations or delusions that put the patient or others at risk

But these medications should always be a last resort—not the first line of defense for a patient who’s simply confused or agitated due to pain, unmet needs, or overstimulation.

Behavioral symptoms in elder care are often a sign of something else:

Before reaching for a prescription pad, the care team should assess and address those root causes.

In many cases, non-drug interventions—like music therapy, structured daily routines, or simply adjusting lighting and noise—can significantly reduce agitation and improve well-being without sedation.

In my work, I advocate for patients who can’t always advocate for themselves. That includes:

🔎 Reviewing every psychotropic prescription for clinical appropriateness
📋 Ensuring facilities meet state and federal guidelines, including the required documentation for using these medications in dementia care
💬 Working with the care team to create a plan for gradual dose reduction (GDR) where appropriate
👨‍👩‍👧 Explaining the risks and options to families, so they can make informed decisions

Facilities are often required by the Department of Health and CMS to reduce or justify psychotropic use—and I help make sure they’re doing it right.

Here are questions every family should ask when psychotropic medications are prescribed:

You have the right to ask these questions. And in many cases, asking them could prevent your loved one from being overmedicated or unnecessarily sedated.

When an elderly patient is “acting out,” it’s often because they’re trying to tell us something. The answer isn’t always a pill—it might be comfort, connection, or simply a different environment.

Psychotropic medications should never be used just to make things easier for staff or more convenient for a schedule. They should be used carefully, sparingly, and only when truly needed.

*Please note that nothing in this article is meant to be taken as medical advice. If you would like to discuss the details of your particular scenario, please contact us through the contact page on the website.