In the past few years, our attention has been necessarily focused on the COVID-19 pandemic. Although COVID-19 is still with us, it is time to catch up with progress in other aspects of managing our patients that impacts our long-term care population.

The use of antipsychotic medications for managing troubling behaviors in dementia patients in long term care has certainly inspired a problematic reputation. That has sometimes led to a reluctance to use them when truly indicated, for example in schizophrenia or the psychotic symptoms in Parkinson’s disease. Recently, two studies have been published that provide some useful information differentiating between agents when treating Parkinson’s disease psychosis. Both studies were based on large databases, and both analyzed long term care patients as a subgroup. Remarkably, both showed significantly lower mortality, especially in the first 180 days, in the Parkinson’s disease patients treated with pimavanserin compared to alternative, off-label antipsychotics used to treat hallucinations and delusions associated with Parkinson’s disease psychosis. One of the two studies showed a similar reduction in the nursing home residents. Although Parkinson’s disease psychosis might not be the most common condition in nursing home patients, it is important to understand these studies when treating such patients. Links are provided below to the two studies, Mosholder (2022) and Layton (2022).