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A population-based study of cholinesterase inhibitor use for dementia.
J Am Geriatr Soc. 2007 Oct; 55(10):1517-23.JA

Abstract

OBJECTIVES

To examine current utilization patterns of cholinesterase inhibitor (ChEI) therapy for dementia to determine treatment duration, use in long-term care, how often patients receive these drugs until death, and frequency of switching between the available ChEIs.

DESIGN

A population-based healthcare administrative database study.

SETTING

Patients aged 66 and older from the Canadian province of Ontario who received a new prescription for a ChEI between June 1, 2000, and December 31, 2002. Patients were followed until discontinuation of ChEI therapy, death, or end of the observation period (March 31, 2005).

PARTICIPANTS

Twenty-eight thousand nine hundred and sixty-one patients, including 4,601 residing in long-term care, mean age 80, 63% female.

MEASUREMENTS

Information on diagnosis, medical comorbidity, physician visits, and concomitant medication use was obtained. Estimates of duration of continuous use were determined. The percentage of patients who remained on the initial dose prescribed, the proportion who switched to a second ChEI, and the percentage who remained on ChEIs until death were calculated.

RESULTS

Patients had on average more than 26 physician visits in the year before ChEI therapy, but only 28% had seen a dementia specialist. Concomitant use of potentially inappropriate medications (strongly anticholinergic medications and benzodiazepines) was noted in 37% of patients. The average length of treatment for all patients was 866 days. Many patients (43%) remained on the initial dose prescribed, 6% switched to another ChEI, and 19% died while on ChEI therapy.

CONCLUSION

Elderly patients with dementia are treated for lengthy periods of time with ChEIs in the community and in long-term care facilities. Further research is required to determine whether these utilization patterns are appropriate. It is also unclear whether these results are generalizable to other populations without universal health coverage or drug formulary benefits.

Authors+Show Affiliations

Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. nathan.herrmann@sunnybrook.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17697100

Citation

Herrmann, Nathan, et al. "A Population-based Study of Cholinesterase Inhibitor Use for Dementia." Journal of the American Geriatrics Society, vol. 55, no. 10, 2007, pp. 1517-23.
Herrmann N, Gill SS, Bell CM, et al. A population-based study of cholinesterase inhibitor use for dementia. J Am Geriatr Soc. 2007;55(10):1517-23.
Herrmann, N., Gill, S. S., Bell, C. M., Anderson, G. M., Bronskill, S. E., Shulman, K. I., Fischer, H. D., Sykora, K., Shi, H. S., & Rochon, P. A. (2007). A population-based study of cholinesterase inhibitor use for dementia. Journal of the American Geriatrics Society, 55(10), 1517-23.
Herrmann N, et al. A Population-based Study of Cholinesterase Inhibitor Use for Dementia. J Am Geriatr Soc. 2007;55(10):1517-23. PubMed PMID: 17697100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A population-based study of cholinesterase inhibitor use for dementia. AU - Herrmann,Nathan, AU - Gill,Sudeep S, AU - Bell,Chaim M, AU - Anderson,Geoffrey M, AU - Bronskill,Susan E, AU - Shulman,Kenneth I, AU - Fischer,Hadas D, AU - Sykora,Kathy, AU - Shi,Haijiang Steven, AU - Rochon,Paula A, Y1 - 2007/08/14/ PY - 2007/8/19/pubmed PY - 2007/11/9/medline PY - 2007/8/19/entrez SP - 1517 EP - 23 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 55 IS - 10 N2 - OBJECTIVES: To examine current utilization patterns of cholinesterase inhibitor (ChEI) therapy for dementia to determine treatment duration, use in long-term care, how often patients receive these drugs until death, and frequency of switching between the available ChEIs. DESIGN: A population-based healthcare administrative database study. SETTING: Patients aged 66 and older from the Canadian province of Ontario who received a new prescription for a ChEI between June 1, 2000, and December 31, 2002. Patients were followed until discontinuation of ChEI therapy, death, or end of the observation period (March 31, 2005). PARTICIPANTS: Twenty-eight thousand nine hundred and sixty-one patients, including 4,601 residing in long-term care, mean age 80, 63% female. MEASUREMENTS: Information on diagnosis, medical comorbidity, physician visits, and concomitant medication use was obtained. Estimates of duration of continuous use were determined. The percentage of patients who remained on the initial dose prescribed, the proportion who switched to a second ChEI, and the percentage who remained on ChEIs until death were calculated. RESULTS: Patients had on average more than 26 physician visits in the year before ChEI therapy, but only 28% had seen a dementia specialist. Concomitant use of potentially inappropriate medications (strongly anticholinergic medications and benzodiazepines) was noted in 37% of patients. The average length of treatment for all patients was 866 days. Many patients (43%) remained on the initial dose prescribed, 6% switched to another ChEI, and 19% died while on ChEI therapy. CONCLUSION: Elderly patients with dementia are treated for lengthy periods of time with ChEIs in the community and in long-term care facilities. Further research is required to determine whether these utilization patterns are appropriate. It is also unclear whether these results are generalizable to other populations without universal health coverage or drug formulary benefits. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/17697100/A_population_based_study_of_cholinesterase_inhibitor_use_for_dementia_ L2 - https://doi.org/10.1111/j.1532-5415.2007.01377.x DB - PRIME DP - Unbound Medicine ER -