Cholinesterase inhibitor and memantine use in newly admitted nursing home residents with dementia.
Cholinesterase inhibitor and memantine use in newly admitted nursing home residents with dementia.
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DOI：
10.1111/j.1532-5415.2011.03478.x
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发表时间：
2011-07
影响因子：
6.3
通讯作者：
Tjia J
中科院分区：
文献类型：
--
作者：
Parsons C;Briesacher BA;Givens JL;Chen Y;Tjia J
量化胆碱酯酶抑制剂（ChEI）和美金刚在养老院（NH）住院时和3个月后痴呆患者中的使用，并检查与治疗减少相关的因素。回顾性队列研究。全国样本美国NHS。2006年新入院的3506名患有痴呆症的NH居民。来自药房配药记录的数据用于确定NH入院时和3个月随访时ChEI和美金刚药物的使用。最小数据集被用来确定居民和设施一级的特点。痴呆的严重程度使用认知能力量表（CPS）定义。总体而言，40.1%（n = 1，407）新入院的NH痴呆患者在NH入院时接受了ChEI和美金刚。入院时ChEI和美金刚的使用在轻度至中重度痴呆患者（41.2%）中显著高于晚期痴呆患者（33.3%，P = 0.001）。3个月后，ChEI和美金刚胺的使用在两组中都减少了大约一半（轻度至中度痴呆为48.6%，晚期痴呆为57.0%，P<0.05）。患有晚期痴呆症的NH居民比患有轻度至中度痴呆症的人更有可能减少ChEI和美金刚的使用（比值比=1.44，95%置信区间=1.03-2.01，P = 0.04）。许多患有晚期痴呆症的NH居民在NH入院时接受ChEI和美金刚胺，其中大约一半在随后的几个月内减少了药物使用。需要进一步研究以优化ChEI和美金刚在NH人群中的使用，并确定撤回治疗对居民结局的影响。
To quantify the use of cholinesterase inhibitors (ChEIs) and memantine in nursing home (NH) residents with dementia upon NH admission and 3 months later and to examine factors associated with reduction in therapy. Retrospective cohort study. Nationwide sample of U.S. NHs. Three thousand five hundred six NH residents with dementia newly admitted in 2006. Data from pharmacy dispensing records were used to determine ChEI and memantine medication use upon NH admission and at 3-month follow-up. The Minimum Data Set was used to determine resident- and facility-level characteristics. Severity of dementia was defined using the Cognitive Performance Scale (CPS). Overall, 40.1% (n =1,407) of newly admitted NH residents with dementia received ChEIs and memantine on NH admission. Use of ChEIs and memantine on admission was significantly greater in residents with mild to moderately severe dementia (41.2%) than in those with advanced dementia (33.3%, P =.001). After 3 months, ChEI and memantine use decreased by about half in both groups (48.6% with mild to moderately severe dementia vs 57.0% with advanced dementia, P<.05). NH residents with advanced dementia were significantly more likely reduce their use of ChEIs and memantine than those with mild to moderately severe dementia (odds ratio =1.44, 95% confidence interval =1.03–2.01, P =.04). Many NH residents with advanced dementia receive ChEIs and memantine upon NH admission, and approximately half of these decrease their medication use over the ensuing months. Further study is required to optimize use of ChEIs and memantine in NH populations and to determine the effects of withdrawing therapy on resident outcomes.