Antidementia Medication Use in Nursing Home Residents

Abstract

Background Antidementia medication can provide symptomatic improvements in patients with Alzheimer’s disease, but there is a lack of consensus guidance on when to start and stop treatment in the nursing home setting. Methods We describe utilization patterns of cholinesterase inhibitors (ChEI) and memantine for 3,50,197 newly admitted NH residents with dementia between 2011 and 2018. Results Overall, pre-admission use of antidementia medications declined from 2011 to 2018 (ChEIs: 44.5% to 36.9%; memantine: 27.4% to 23.2%). Older age, use of a feeding tube, and greater functional dependency were associated with lower odds of ChEI initiation. Coronary artery disease, parenteral nutrition, severe aggressive behaviors, severe cognitive impairment, and high functional dependency were associated with discontinuation of ChEIs. Comparison of clinical factors related to anti-dementia drug treatment changes from pre to post NH admission in 2011 and 2018 revealed a change toward lower likelihood of initiation of treatment among residents with more functional dependency and those with indicators of more complex illness as well as a change toward higher likelihood of discontinuation in residents having 2 or more hospital stays. Conclusions These prescribing trends highlight the need for additional research on the effects of initiating and discontinuing antidementia medications in the NH to provide clear guidance for clinicians when making treatment decisions for individual residents.

Geographic Variation of Antidementia and Antipsychotic Medication Use Among US Nursing Home Residents With Dementia

“…13 A national study of newly admitted NH residents from 2011 to 2018 reported a lower odds of initiating ChEIs and memantine after admission and a higher odds of discontinuing antidementia medications among those who were using antipsychotics before admission. 14 In that study, initiation and/or discontinuation of antidementia medications after admission were also associated with dementia severity and other factors including age, Medicaid enrollment, recent hospitalizations, comorbid mental health conditions, and polypharmacy. 14 Other studies have focused only on antidementia medication use.…”

“…14 In that study, initiation and/or discontinuation of antidementia medications after admission were also associated with dementia severity and other factors including age, Medicaid enrollment, recent hospitalizations, comorbid mental health conditions, and polypharmacy. 14 Other studies have focused only on antidementia medication use. An analysis of the 2004 National NH Survey indicated that approximately 30% of NH residents with dementia were being treated with ChEIs.…”

“…16 A more recent national study estimated that 58% of newly admitted residents with dementia used ChEIs preadmission in 2011, then declining to 49% in 2018. 14 Memantine use at admission among those with dementia declined from 40% to 35% from 2011 to 2018. The basis for such changing utilization patterns over time is poorly understood.…”

“…Throughout the 2011-2018 period, about 1 in 8 ChEI and memantine users preadmission had discontinued use within 3 months after admission. 14 One approach to identifying possible influences on prescribing patterns is to examine resident, facility, and geographic variations in drug prescription prevalence. Prior research among all Medicare enrollees with a dementia diagnosis reported the use of antidementia drugs was lower among newly diagnosed patients in residential care and varied by region of residence.…”