Tardive dyskinesia (TD) can be easy to overlook in nursing facility residents. Although second-generation antipsychotics (SGAs) are often perceived as carrying a lower risk, residents can still develop persistent involuntary movements, particularly with long-term use, advanced age, and polypharmacy.
One ongoing concern is the inappropriate use of benztropine. Recent prescribing patterns suggest that benztropine may still be prescribed prophylactically alongside antipsychotics or added in response to suspected TD. However, benztropine is **not indicated for the treatment of TD and may actually worsen symptoms.**
Benztropine may be appropriate for the treatment of drug-induced Parkinsonism or acute dystonia—conditions that can sometimes be mistaken for TD. Because these movement disorders require different treatment approaches, accurate identification is essential before initiating or continuing anticholinergic therapy.
For residents with confirmed or strongly suspected TD, treatment should focus on therapies specifically approved for the condition. VMAT2 inhibitors, including Ingrezza® (valbenazine) and Austedo® (deutetrabenazine), offer a more appropriate treatment approach than anticholinergic medications.
Improving the recognition and management of TD presents an important opportunity to enhance resident care. Early identification can lead to more timely interventions, improved comfort, and better clinical outcomes.
From a facility perspective, supporting evidence-based treatment decisions can also help align care with current best practices and quality-focused initiatives. Appropriate management of TD benefits both resident-centered outcomes and overall facility performance.
Small actions can make a meaningful difference in identifying TD and supporting timely treatment.
By recognizing TD early and advocating for evidence-based treatment, nursing teams can help improve resident comfort, dignity, safety, and quality of life.
