Almost all people with dementia will develop changes in mood, perception or behavior. In nursing homes, many are inappropriately treated with antipsychotic medications that bring serious health risks. When dementia patients act out: Can non-drug approaches ease their lives?
Federal statistics show nursing homes still overuse medications to quell the behavioral problems that come with cognitive decline. Experts think there are better ways. After Bobby Tweed moved into a Tennessee nursing home, the spirited 78-year-old with dementia grew listless and withdrawn.
Tweed, a gentle man who his daughter says “never hit anybody in his whole life,” was suddenly labeled “agitated” after a scuffle with another resident. In reality, Tweed was suffering from a common, treatable urinary tract infection, a physical condition well known to trigger temporary delirium and behavioral changes in dementia patients. Doctors treated him for the infection, but facility staff still turned to powerful psychotropic drugs that, according to a wrongful death lawsuit, were administered without his family’s knowledge or consent.
The medications achieved what they were meant to do: They stopped behaviors caregivers found difficult. Tweed was left in a stupor so deep that family members who came to visit at different times of the day could not wake him up. As her father retreated behind a chemical haze, Keller was left wondering whether what staff called “agitation” was really a language that no one had tried hard enough to understand.
That possibility is at the center of an ongoing struggle in dementia care. While memory loss is the hallmark of dementia, the disease is also marked by troubling changes in behavior — such as aggression, shouting, irritability and depression. These symptoms are frequently treated with antipsychotics, despite longstanding warnings about serious risks of their use in older adults with dementia.
A pair of 2026 federal watchdog reports indicate that the practice remains deeply entrenched in US nursing homes. The Department of Health and Human Services Office of Inspector General found that facilities still use the medications as “chemical restraints,” often without first attempting required non-pharmacological interventions. Investigators also detailed how some facilities hide their true prescribing rates by inappropriately diagnosing residents with schizophrenia, a condition excluded from federal quality measures tracking antipsychotic use.
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