Cholinesterase inhibitor use in nursing homes
Approximately One-Third of Nursing Home Residents With Dementia Use Cholinesterase Inhibitors: Presented at AAGP
By Emma Hitt, PhD
HONOLULU -- March 8, 2009 -- Cholinesterase inhibitors are used in about 30% of nursing home patients with dementia, according to the findings of a population-based study presented here at the American Association for Geriatric Psychiatry (AAGP) 22nd Annual Meeting.
Dallas P. Seitz, MD, Kunin-Lunenfeld Applied Research Unit, Baycrest Centre, Toronto, Ontario, and colleagues presented these findings here on March 7.
The team used data from the National Nursing Home Survey, which included 5,866 patients (49%) with dementia out of 11,940 survey participants aged 65 years or older.
Among nursing home residents with dementia, a projected 199,296 individuals (30.0%) in the total US nursing home population were receiving cholinesterase inhibitors, Dr. Seitz's team reported. Among the patients receiving cholinesterase inhibitors, 71% were receiving donepezil, while rivastigmine and galantamine accounted for 14% and 15% of the prescriptions, respectively.
A multivariate logistic regression analysis indicated that use of these agents was independently associated with decreased age (odds ratio [OR] = 0.42; 95% confidence interval [CI], 0.27-0.62 for those over 95 years of age compared with those aged 65 to 74 years).
The use of these agents was also associated with decreased activities of daily living (ADL) impairment (OR = 0.49; 95% CI, 0.42-0.58, for severe vs mild ADL impairment) as well as a significantly increased use of antipsychotics and antidepressants.
"There was no difference between groups in terms of [their] residence in private or non-nursing home or metropolitan communities compared to nonmetropolitan communities," the researchers noted. "Users of cholinesterase inhibitors were, however, more likely to reside in a nursing home with a greater number of beds when compared to nonusers."
"Most randomised, controlled trials of cholinesterase inhibitors for dementia are in individuals with mild to moderate Alzheimer's dementia," Dr. Seitz's team noted. "Recently, there has been increasing interest in the use of these agents in individuals with more severe dementia, which may be more representative of nursing home residents."
Funding for the study was provided by the Alzheimer's Society of Canada and the Canadian Institutes of Health Research.
[Presentation title: Cholinesterase Inhibitors in US Nursing Homes: Results From the National Nursing Home Survey. Abstract EI 10]
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