{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:23:23Z","timestamp":1787315003707,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T00:00:00Z","timestamp":1730764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG056407"],"award-info":[{"award-number":["R01AG056407"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG074957"],"award-info":[{"award-number":["R01AG074957"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exposure to central nervous system (CNS)\u2010active polypharmacy\u2014overlapping exposure to three or more CNS\u2010active medications\u2014is potentially harmful yet common among persons living with dementia (PLWD). The extent to which these medications are prescribed to community\u2010dwelling PLWD by individual clinicians versus distributed across multiple prescribers is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified community\u2010dwelling Medicare beneficiaries with a dementia diagnosis and Medicare Parts A, B, and D coverage for at least one month in 2019. Using fill date and days' supply for prescriptions filled between January 1, 2019 and December 31, 2019, we identified beneficiaries exposed to CNS\u2010active polypharmacy (i.e., &gt;30\u2009days of overlapping exposure to three or more antidepressant, antipsychotic, antiseizure, benzodiazepine, opioid, nonbenzodiazepine benzodiazepine receptor agonists, or skeletal muscle relaxant medications). We examined the number and type of clinicians who contributed to polypharmacy person\u2010days among PLWD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 955,074 PLWD who were primarily female (64.0%), were White (78.5%), and had a mean age of 83.4\u2009years (standard deviation 8.0). Notably, 14.3% were exposed to CNS\u2010active polypharmacy. At the person level, 24.6% of PLWD experienced polypharmacy prescribed by a single clinician. Considering total days of exposure, 45.3% of polypharmacy person\u2010days were prescribed by a single clinician. Primary care physicians prescribed 63.0% of polypharmacy person\u2010days and accounted for the plurality of days for all seven medication classes, followed by psychiatrists for antipsychotics and benzodiazepines and primary care advanced practice providers (APPs) for antidepressants and antiseizure medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this cross\u2010sectional analysis of Medicare claims data, primary care clinicians (both physicians and APPs) prescribed the majority of medications that contributed to CNS\u2010active polypharmacy for PLWD. Future research is needed to identify strategies to support primary care clinicians in appropriate prescribing of CNS\u2010active medications to PLWD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.19256","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T08:45:23Z","timestamp":1730796323000},"page":"422-430","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Clinician contributions to central nervous system\u2010active polypharmacy among older adults with dementia in the\n                    <scp>United States<\/scp>"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9828-9759","authenticated-orcid":false,"given":"Sarah E.","family":"Vordenberg","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy University of Michigan College of Pharmacy  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel C.","family":"Davis","sequence":"additional","affiliation":[{"name":"Michigan Medicine  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Strominger","sequence":"additional","affiliation":[{"name":"VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C.","family":"Marcus","sequence":"additional","affiliation":[{"name":"Social Policy and Practice University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyungjin Myra","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Statistical Consulting and Research University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Biostatistics University of Michigan School of Public Health  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic C.","family":"Blow","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Michigan Medical School  Ann Arbor Michigan USA"},{"name":"Department of Psychology University of Michigan College of Literature, Science, and the Arts  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren P.","family":"Wallner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan Medical School  Ann Arbor Michigan USA"},{"name":"Department of Epidemiology University of Michigan School of Public Health  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanner","family":"Caverly","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan Medical School  Ann Arbor Michigan USA"},{"name":"Learning Health Sciences University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Krein","sequence":"additional","affiliation":[{"name":"VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4740-2640","authenticated-orcid":false,"given":"Donovan T.","family":"Maust","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Michigan Medical School  Ann Arbor Michigan USA"},{"name":"Ann Arbor VA Center for Clinical Management Research  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.3543"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12362"},{"key":"e_1_2_11_4_1","unstructured":"FreedmanVA CornmanJC KasperJD.National health and aging trends study trends chart book: key trends measures and detailed tables. 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