For people with dementia, medicines aimed at distressing behaviour became less common over a decade—but taking several of these medicines at once still affected almost one person in five by the end. Dementia affects more than 55 million people worldwide, and more than 436,000 people in Australia.

Two-thirds of Australians with dementia live in the community, rather than in residential care. Alongside memory problems, dementia can bring agitation, aggression, depression, anxiety, false beliefs, and hallucinations. These symptoms can lower quality of life, lead to hospital stays, and raise health costs, although they often settle on their own within six months.

Inappropriate use of psychotropic medicines in older people, particularly those with dementia, has become a significant concern in recent years. Australia responded with joint efforts, recommendations for aged care, and updated guidance.

But evidence was still needed about what was happening in ordinary general practices, both for people with dementia and for similar people without it. To follow that change, the study used information routinely recorded by general practitioners across Australia.

The records included diagnoses, prescriptions, visits, basic personal information, observations, and laboratory tests. The records did not include the free-text progress notes, which may contain patient-specific information. The practices included in the study represented the Australian population in terms of age and sex.

The core comparison was simple: track people aged sixty-five and older with a recorded dementia diagnosis across the years from 2011 to 2020, and compare them with similar people without dementia. The study then looked for changes over time, rather than treating prescribing in one year as the whole story.

Antipsychotic prescribing was consistently at least twice as common among people with dementia as among their matched counterparts, but it fell steadily in both groups over the decade. The gap remained across ages, sexes, and places of residence, making the overall decline important but incomplete.

Taking two or more psychotropic medicines at once was more common among people with dementia than among the matched controls. But it fell from 21.7 percent to 18.1 percent in the dementia groups, while it rose slightly in the controls. The use of three or more such medicines also dropped slightly among people with dementia, while it increased among the controls.

A separate check using unmatched groups found a similar pattern. The burden was not evenly shared: people with dementia outside major cities were more likely to receive several mental-health medicines at once, although this fell over the decade. By twenty twenty, it was still about one in five in inner regional areas.

The comparison between people with and without dementia was designed to account for other conditions that might lead to psychotropic treatment. That means the difference should largely reflect treatment for the behaviour and psychological symptoms linked with dementia.

The records did not show how severe each person’s dementia was, so the study could not examine whether psychotropic prescribing differed by severity. Australian general practice saw encouraging reductions, especially in medicines used for severe behaviour symptoms.

But multiple psychotropic medicines remain common, particularly outside major cities, so safer prescribing still matters.