After Bobby Tweed moved into a Tennessee nursing home, the spirited 78-year-old with dementia grew listless and withdrawn.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. The issue extends beyond care homes to older adults receiving care in a range of settings, including those living in residential facilities and those remaining in their own homes. In all, national prescribing data show that antipsychotic use among adults 65 and older increased by nearly 52 percent between 2015 and 2024, with long-term use (defined as more than four months) rising by almost 65 percent.
The analysis included more than 8 million older Americans who received at least one antipsychotic prescription, reflecting the broad use of drugs whose benefits and risks remain hotly debated. In response, many clinicians and advocates are pushing for a different approach. Rather than treating these dementia-related actions as symptoms to be suppressed, they are instead describing them as expressions of unmet needs.
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