Pharmacotherapeutic Management of Dementia Across Settings of Care. Issue 5 (16th April 2013)

• Record Type: Journal Article
• Authors: Rattinger, Gail B.; Burcu, Mehmet; Dutcher, Sarah K.; Chhabra, Pankdeep T.; Rosenberg, Paul B.; Simoni‐Wastila, Linda; Franey, Christine S.; Walker, Loreen D.; Zuckerman, Ilene H.
• Is Part Of: Journal of the American Geriatrics Society. Volume 61:Issue 5(2013:May)
• Page Start: 723
• Page End: 733
• Publication Date: 2013-04-16
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12210
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" xml:lang="en" id="jgs12210-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12210-sec-0001" sec-type="section"> <title>Objectives</title> <p>To describe population‐based use of cognitive‐enhancing and psychopharmacological medications across care settings in Medicare beneficiaries with dementia.</p> </sec> <sec id="jgs12210-sec-0002" sec-type="section"> <title>Design</title> <p>One‐year (2008) cross‐sectional study.</p> </sec> <sec id="jgs12210-sec-0003" sec-type="section"> <title>Setting</title> <p>Medicare administrative claims from a 5% random sample.</p> </sec> <sec id="jgs12210-sec-0004" sec-type="section"> <title>Participants</title> <p>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 <italic>International Classification of Diseases, Ninth Revision, Clinical Modification</italic> code was required before 2008, and an additional claim was required in 2008 to confirm active disease.</p> </sec> <sec id="jgs12210-sec-0005" sec-type="section"> <title>Measurements</title> <p>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).</p> </sec> <sec id="jgs12210-sec-0006" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="jgs12210-sec-0007" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>