Dementia-related behaviors can be difficult for care staff to address. An article in Seniors Housing & Care Journal investigated the prevalence of off-label antipsychotic medication use in assisted living communities throughout Virginia.

Researchers contacted administrators at all 468 assisted living facilities in Virginia to complete a survey regarding the prevalence of off-label antipsychotic medication use and nonpharmacological behavioral interventions for residents with dementia. Surveys from 55 facilities were returned. The researchers then interviewed nine assisted living staff members from three of the facilities that reported low, moderate, or high antipsychotic medication use.

The responding facilities reported an average of 55 residents, of which about half had a diagnosis of dementia but no other mental health conditions. Of these residents, 42% had been prescribed an off-label antipsychotic medication, which is much higher than the average 15% prescribed rate in Virginia nursing homes. For-profit facilities had a higher percentage of residents taking off-label antipsychotic medication than not-for-profit communities (49% vs 27%, respectively). Through interviews, staff reported many residents had already been prescribed antipsychotic medicines when they moved to the community.

Regarding use of antipsychotics, staff reported it was generally effective in calming residents and managing behavior, however side effects such as drowsiness and altered mood were common. All staff members reported employing nonpharmacological approaches before administering medication. Examples included satisfying hunger or thirst, calming with a distracting activity, reducing environmental stimulation, and taking a person-centered approach.

The interviewees were also concerned that there were insufficient staff, time, training, and protocols to fully manage dementia-related behaviors. This is also reflected in the survey data: only 24% of responding facilities employed specific nonpharmacological behavioral interventions, such as the Alzheimer’s Association program Accepting the Challenge.

Due to the relatively small sample, results from this study may not necessarily be generalizable to assisted living throughout the US. However, the findings shed light on some important concerns that may help community leadership to reexamine their policies and procedures. Staff seemed to address dementia-related behaviors as best as they knew how before administering medication, but could benefit from enhanced training, more supportive protocols, and integrating behavioral health specialists into residents’ care.


Want to keep up with recent research that’s relevant to aging services? Use the form below to subscribe to our monthly InvestigAge email.



Inker J, Pryor J, Arbogast C, Op De Beke M, and Okhravi H. “Can you just give us something to help her?” Off-label use of antipsychotic medication in Virginia assisted living facilities. Seniors Housing & Care Journal (2020) 28(1), 3-15.