Antidementia Medication Use in Nursing Home Residents.
Antidementia Medication Use in Nursing Home Residents.
复制标题
DOI：
10.1177/08919887231202948
复制
发表时间：
2023-09
影响因子：
2.6
通讯作者：
Brian R Ott;Carl Hollins;J. Tjia;Jonggyu Baek;Qiaoxi Chen;Kate L. Lapane;M. Alcusky
中科院分区：
文献类型：
--
作者：
Brian R Ott;Carl Hollins;J. Tjia;Jonggyu Baek;Qiaoxi Chen;Kate L. Lapane;M. Alcusky
抗痴呆药物可以改善阿尔茨海默病患者的症状，但在疗养院环境中何时开始和停止治疗缺乏共识指导。方法我们描述了2011年至2018年期间3，50，197名新入院的NH痴呆患者的胆碱酯酶抑制剂（ChEI）和美金刚的使用模式。总体而言，入院前抗痴呆药物的使用从2011年到2018年有所下降（ChEI：44.5%至36.9%;美金刚：27.4%至23.2%）。年龄较大、使用饲管和更大的功能依赖性与ChEI启动几率较低相关。冠状动脉疾病、肠外营养、严重攻击行为、严重认知障碍和高度功能依赖与停用ChEI相关。与2011年和2018年NH入院前后抗痴呆药物治疗变化相关的临床因素的比较显示，功能依赖性更强的居民和具有更复杂疾病指标的居民开始治疗的可能性更低，住院2次或以上的居民停止治疗的可能性更高。结论这些处方趋势强调了需要对NH中启动和停用抗痴呆药物的影响进行额外的研究，以便为临床医生在为个体居民做出治疗决定时提供明确的指导。
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.