Pharmacotherapeutic management of dementia across settings of care.

Abstract

OBJECTIVES:

To describe population-based use of cognitive-enhancing and psychopharmacological medications across care settings in Medicare beneficiaries with dementia.

DESIGN:

One-year (2008) cross-sectional study.

SETTING:

Medicare administrative claims from a 5% random sample.

PARTICIPANTS:

Medicare beneficiaries with dementia aged 65 and older with continuous Medicare Parts A, B, and D coverage and alive throughout 2008. To ascertain dementia, one or more medical claims with a dementia International Classification of Diseases, Ninth Revision, Clinical Modification code was required before 2008, and an additional claim was required in 2008 to confirm active disease.

MEASUREMENTS:

Use of medications commonly prescribed in managing dementia (cognitive enhancers, antidepressants, antipsychotics, and mood stabilizers) was assessed using three measures: annual prevalence of use, consistency of use, and count of psychopharmacological medication classes. Care setting was determined using the number of months of nursing home (NH) residency: no NH (0 months), partial NH (1-11 months), and full NH (12 months).

RESULTS:

Community-dwellers represented 41.3% of the cohort, whereas 42.4% and 16.3% resided partially and fully in a NH, respectively. Annual prevalence of use was 57.1% for cognitive enhancers, 56.4% for antidepressants, 34.0% for antipsychotics, and 8.8% for mood stabilizers. Cognitive enhancer use was significantly lower in those with any NH stay (partial NH vs no NH, adjusted prevalence ratio (APR) = 0.84, 99% confidence interval (CI) = 0.83-0.86; full NH vs no NH, APR = 0.83, 99% CI = 0.81-0.85). In contrast, those with any NH residence had significantly higher use of all psychopharmacological medication classes than community-dwellers. More than half the cohort had consistent medication regimens during 2008 (64.8%). The number of psychopharmacological medication classes used increased with increasing NH stay duration.

CONCLUSION:

This population-based study documents significant differences in medication use for managing dementia between care settings and substantial use of psychopharmacological medications in older adults with dementia.

• Authors: Gail B Rattinger, Mehmet Burcu, Sarah K Dutcher, Pankdeep T Chhabra, Paul B Rosenberg, Linda Simoni-Wastila, Christine S Franey, Loreen D Walker, Ilene H Zuckerman
• Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 61 Issue 5 Pg. 723-33 (May 2013) ISSN: 1532-5415 [Electronic] United States
• PMID: 23590231 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Chemical References

• Antipsychotic Agents
• Prescription Drugs

Topics

• Aged
• Aged, 80 and over
• Antipsychotic Agents (economics, therapeutic use)
• Cross-Sectional Studies
• Dementia (drug therapy, economics, epidemiology)
• Female
• Follow-Up Studies
• Humans
• Male
• Medicare (economics)
• Prescription Drugs (economics, therapeutic use)
• Prevalence
• Retrospective Studies
• United States (epidemiology)