ArticleJournal of the American Geriatrics Society2021
Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014-2016.
Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of 'very high' Human Development Index English-speaking countries.BMC palliative care · 2022Pooled it
- Safeguarding palliative and serious illness care in America.Lancet regional health. Americas · 2026Review
- Benzodiazepine or Antipsychotic Use and Mortality Risk Among Patients With Dementia in Hospice Care.JAMA network open · 2025Article
- Exploring Antipsychotic Initiation Among Persons Living With Dementia in a Comprehensive Dementia Care Program.Journal of the American Geriatrics Society · 2025Article
- Medications Reported to the Medicare Hospice Program after Medicare Drug Policy Changes, 2014-2018.Journal of pain and symptom management · 2025Article
- Behavioral symptoms and treatment challenges for patients living with dementia: Hospice clinician and caregiver perspectives.Journal of the American Geriatrics Society · 2025Article
- Differences in Medication Use by Gender and Race in Hospitalized Persons Living with Dementia.Journal of racial and ethnic health disparities · 2024Article
- Naming racism as a root cause of inequities in palliative care research: a scoping review.BMC palliative care · 2024Article
- Factors Associated With Benzodiazepine and Antipsychotic Prescribing in Hospice: A Qualitative Study of Hospice Prescribers.Journal of the American Medical Directors Association · 2023Article
- Hospice agency characteristics associated with benzodiazepine and antipsychotic prescribing.Journal of the American Geriatrics Society · 2023Article
- How to Improve Clinical Outcomes and Reduce Cardiovascular Risk in Older People with Cardiovascular Disease: Bridging Evidence Gaps.European cardiology · 2023Review
- State variation in antipsychotic and benzodiazepine prescribing among hospice beneficiaries in the United States.Journal of the American Geriatrics Society · 2022Article
- Variation in Benzodiazepine and Antipsychotic Prescribing Among Hospice Agencies.Journal of general internal medicine · 2022Article
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 1 country.
Funding
Abstract
BACKGROUND/
objectivesPsychotropic and opioid medications are routinely prescribed for symptom management in hospice, but national estimates of prescribing are lacking. Changes in Medicare hospice payment in 2014 provide the first opportunity to examine psychotropic and opioid prescribing among hospice beneficiaries, and the factors associated with use of specific medication classes.
designCross-sectional analysis of a 20% sample of traditional and managed Medicare with Part D enrolled in hospice, 2014-2016.
settingBeneficiaries enrolled in the Medicare hospice benefit.
participantsMedicare beneficiaries ≥65 newly enrolled in hospice between July 1, 2014 and December 31, 2016 (N = 554,022). MAIN OUTCOME: Prevalence of psychotropic and opioid medication prescribing by class and factors associated with prescribing.
results70.3% of hospice beneficiaries were prescribed a psychotropic and 63.3% were prescribed an opioid. The most common psychotropic classes prescribed were: benzodiazepines (60.6%), antipsychotics (38.3%), antidepressants (18.4%), and antiepileptics (10.2%). Lorazepam (56.4%), morphine (52.8%), and haloperidol (28.6%) were received by the most beneficiaries. Prevalence of any psychotropic and opioid prescription was highest among beneficiaries who were female (76.7%), non-Hispanic white (76.6%), and those with cancer (78.9%). Compared to white beneficiaries, non-Hispanic black beneficiaries were less likely to receive nearly every class of medication, with significantly lower odds of receiving opioids (64.1% vs 57.9%; AOR 0.75, 95% CI 0.72-0.77) and benzodiazepines (61.6% vs 52.2%; AOR 0.66, 95% CI 0.64-0.68). Differences were seen across hospice diagnosis; those with cancer were more likely to receive opioids, benzodiazepines, and antipsychotics but less likely to receive antidepressants and antiepileptics.
conclusionsPsychotropic and opioid medications are frequently prescribed in hospice. Observed variations in prescribing across race and ethnicity may reflect disparities in prescribing as well as patient preferences for care. Further work is important to understand factors driving prescribing given limited studies surrounding medication prescribing in hospice.
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