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Stopping long-term antipsychotic treatment in people with dementia reduces the risk of fracture and hospitalisation for delirium, a study has found.
The research, published in the latest issue of The Lancet Healthy Longevity, looked at records for 24,822 people in the UK, aged 65 years and older with dementia, who had been taking antipsychotic medication for at least 12 weeks. Of these, 16,795 patients had been taking antipsychotics for at least 24 weeks.
Guidance from the National Institute for Health and Care Excellence states that if a person with dementia is prescribed antipsychotics, these should be used at the lowest possible dose and for the shortest possible time. The patient must be reassessed every six weeks and the antipsychotic should be stopped if it is not helping or is no longer needed.
However, the study authors said that, in practice, antipsychotic treatment in dementia often exceeds the recommended duration.
The researchers emulated clinical trials to assess the effect of tapering or abruptly stopping antipsychotics in people who had taken them for at least 12 weeks or 24 weeks.
They found that, compared with continuation of antipsychotics, the estimated risks of fracture and hospitalisation for delirium were lower in people who discontinued the drugs after 12 weeks or 24 weeks. They also found that the risk was reduced regardless of whether the drugs were stopped abruptly or tapered.
The researchers also looked at the risk of risk of death, stroke, or pneumonia, which have previously been found to be associated with the use of antipsychotics in dementia. They found that stopping antipsychotics, by either method, did not reduce these risks — although it did not increase them either.
Lead author Olivia Hopkinson, a PhD student in pharmacoepidemiology at University College London, said: “Our findings provide reassurance that stopping long-term antipsychotic treatment in people living with dementia, when it is no longer clinically needed, may reduce harms such as fractures and delirium.
“However, discontinuation is only one part of safer prescribing. Antipsychotic use in dementia is already known to be associated with higher risks of serious outcomes, including stroke, pneumonia, and death, and our study did not find that these risks were reduced after stopping treatment.
“Reducing unnecessary initiation therefore remains essential,” she added.
Ian Maidment, professor in clinical pharmacy at Aston University, said: “This is an important study. The inappropriate and over-use of antipsychotics in people living with dementia continues to be an issue. The use is associated with significant morbidity and we need to understand the impact of stopping antipsychotics and the best way to stop them.”
“This is a real-world problem and antipsychotics can be continued for long periods due to concerns about the original symptoms returning. Pharmacy staff should have a key role ensuring that prescribed psychotropics, including antipsychotics, are regularly reviewed in people living with dementia,” he added.
In October 2025, a study of 9,819 people with dementia who were taking antipsychotics, published in The Lancet Psychiatry, found that patients were prescribed initial antipsychotic treatment for a median of seven months. Almost one-fifth of patients (18%) were initiated on a prescription above the minimum effective dose.
