Pharmacotherapeutic Management of Dementia Across Settings of Care

• Autores: 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
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 61, Nº. 5, 2013, págs. 723-733
• Idioma: inglés
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• Resumen

  • 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.