Pharmacotherapy for Alzheimer's Disease and Dementias in Long-Term Care: A Real-World EHR Study

ObjectivesTo characterize contemporary pharmacologic treatment patterns for Alzheimers disease and related dementias (ADRD) among U.S. long-term care residents and to examine facility- and resident-level factors associated with treatment. DesignRetrospective, observational study. Setting and ParticipantsElectronic health record data from 1,675,873 long-term care residents in the PointClickCare Life Sciences database included 359,801 with a documented ADRD diagnosis in skilled nursing facilities in the U.S. (January-April 2025). MethodsResidents were classified as treated/untreated based on receipt of guideline-directed ADRD therapy, consistent with Alzheimers Association guidelines. Analyses incorporated demographics, comorbidities, medication burden, and facility characteristics. Multivariate logistic regression estimated odds of receiving guideline-concordant therapy. ResultsOverall, 72.5% of residents with ADRD received [≥]1 pharmacologic treatment recommended for ADRD. Treatment was most common among residents with Lewy body dementia (83.9%) and early-onset Alzheimers disease (82.3%) and least frequent among residents aged [≥]90 years (65.1%), Black/African American residents (66.8%), and those with cerebral degeneration (66.8%). Treated residents exhibited higher medication burden (mean 4.4 vs 3.3). Diagnoses for other chronic conditions as well as specific ADRD subtypes strongly impacted probability of treatment; diabetes and hyperlipidemia were associated with lower odds of treatment, whereas ADRD subtypes strongly predicted treatment. Conclusions and ImplicationsMore than one-quarter of residents with ADRD remain untreated with guideline-recommended pharmacotherapy, and treatment varied significantly by non-clinical predictors. These findings underscore the need to investigate and understand possible treatment disparities, optimize polypharmacy management, and discover new ADRD treatments, as current options are often ineffective with many side effects. Brief SummaryThis study used real-world data from electronic health records (EHR) to understand treatment patterns of those with Alzheimers disease and related dementias (ADRD) in U.S. long-term care facilities. International Classification of Diseases Tenth Revision, Clinical Modification (ICD-10) codes were used to identify ADRD diagnoses and medication orders were used to identify treatment. From January to April 2025, there were 359,801 with a documented ADRD diagnosis in skilled nursing facilities. Over 25% of those with ADRD did not have a medication order for a guideline-recommended pharmacological treatment. Comorbidities of diabetes and hyperlipidemia were associated with lower odds of receiving ADRD treatment, suggesting concerns related to adverse drug reactions and competing clinical priorities. The use of cognitive and disease-modifying therapies was low compared to behavioral/psychiatric medications; this finding suggests a need for more effective and safe drugs that target the root causes of ADRD opposed to the behavioral and psychiatric complications. Taken together, the results of this study call for targeted interventions to address disparities in treatment, enhanced clinical decision-making support regarding polypharmacy, and improved pharmacological options for those with ADRD.