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Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia.
BMC Psychiatry. 2011 Dec 06; 11:190.BP

Abstract

BACKGROUND

Although most guidelines recommend the use of cholinesterase inhibitors (ChEIs) for mild to moderate Alzheimer's Disease, only a small proportion of affected patients receive these drugs. We aimed to study if geriatric comorbidity and polypharmacy influence the prescription of ChEIs in patients with dementia in Germany.

METHODS

We used claims data of 1,848 incident patients with dementia aged 65 years and older. Inclusion criteria were first outpatient diagnoses for dementia in at least three of four consecutive quarters (incidence year). Our dependent variable was the prescription of at least one ChEI in the incidence year. Main independent variables were polypharmacy (defined as the number of prescribed medications categorized into quartiles) and measures of geriatric comorbidity (levels of care dependency and 14 symptom complexes characterizing geriatric patients). Data were analyzed by multivariate logistic regression.

RESULTS

On average, patients were 78.7 years old (47.6% female) and received 9.7 different medications (interquartile range: 6-13). 44.4% were assigned to one of three care levels and virtually all patients (92.0%) had at least one symptom complex characterizing geriatric patients. 13.0% received at least one ChEI within the incidence year. Patients not assigned to the highest care level were more likely to receive a prescription (e.g., no level of care dependency vs. level 3: adjusted Odds Ratio [OR]: 5.35; 95% CI: 1.61-17.81). The chance decreased with increasing numbers of symptoms characterizing geriatric patients (e.g., 0 vs. 5+ geriatric complexes: OR: 4.23; 95% CI: 2.06-8.69). The overall number of prescribed medications had no influence on ChEI prescription and a significant effect of age could only be found in the univariate analysis. Living in a rural compared to an urban environment and contacts to neurologists or psychiatrists were associated with a significant increase in the likelihood of receiving ChEIs in the multivariate analysis.

CONCLUSIONS

It seems that not age as such but the overall clinical condition of a patient including care dependency and geriatric comorbidities influences the process of decision making on prescription of ChEIs.

Authors+Show Affiliations

University of Bremen, Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, Bremen, Germany. hoffmann@zes.uni-bremen.deNo 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22145796

Citation

Hoffmann, Falk, et al. "Impact of Geriatric Comorbidity and Polypharmacy On Cholinesterase Inhibitors Prescribing in Dementia." BMC Psychiatry, vol. 11, 2011, p. 190.
Hoffmann F, van den Bussche H, Wiese B, et al. Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia. BMC Psychiatry. 2011;11:190.
Hoffmann, F., van den Bussche, H., Wiese, B., Schön, G., Koller, D., Eisele, M., Glaeske, G., Scherer, M., & Kaduszkiewicz, H. (2011). Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia. BMC Psychiatry, 11, 190. https://doi.org/10.1186/1471-244X-11-190
Hoffmann F, et al. Impact of Geriatric Comorbidity and Polypharmacy On Cholinesterase Inhibitors Prescribing in Dementia. BMC Psychiatry. 2011 Dec 6;11:190. PubMed PMID: 22145796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia. AU - Hoffmann,Falk, AU - van den Bussche,Hendrik, AU - Wiese,Birgitt, AU - Schön,Gerhard, AU - Koller,Daniela, AU - Eisele,Marion, AU - Glaeske,Gerd, AU - Scherer,Martin, AU - Kaduszkiewicz,Hanna, Y1 - 2011/12/06/ PY - 2011/08/19/received PY - 2011/12/06/accepted PY - 2011/12/8/entrez PY - 2011/12/8/pubmed PY - 2012/4/7/medline SP - 190 EP - 190 JF - BMC psychiatry JO - BMC Psychiatry VL - 11 N2 - BACKGROUND: Although most guidelines recommend the use of cholinesterase inhibitors (ChEIs) for mild to moderate Alzheimer's Disease, only a small proportion of affected patients receive these drugs. We aimed to study if geriatric comorbidity and polypharmacy influence the prescription of ChEIs in patients with dementia in Germany. METHODS: We used claims data of 1,848 incident patients with dementia aged 65 years and older. Inclusion criteria were first outpatient diagnoses for dementia in at least three of four consecutive quarters (incidence year). Our dependent variable was the prescription of at least one ChEI in the incidence year. Main independent variables were polypharmacy (defined as the number of prescribed medications categorized into quartiles) and measures of geriatric comorbidity (levels of care dependency and 14 symptom complexes characterizing geriatric patients). Data were analyzed by multivariate logistic regression. RESULTS: On average, patients were 78.7 years old (47.6% female) and received 9.7 different medications (interquartile range: 6-13). 44.4% were assigned to one of three care levels and virtually all patients (92.0%) had at least one symptom complex characterizing geriatric patients. 13.0% received at least one ChEI within the incidence year. Patients not assigned to the highest care level were more likely to receive a prescription (e.g., no level of care dependency vs. level 3: adjusted Odds Ratio [OR]: 5.35; 95% CI: 1.61-17.81). The chance decreased with increasing numbers of symptoms characterizing geriatric patients (e.g., 0 vs. 5+ geriatric complexes: OR: 4.23; 95% CI: 2.06-8.69). The overall number of prescribed medications had no influence on ChEI prescription and a significant effect of age could only be found in the univariate analysis. Living in a rural compared to an urban environment and contacts to neurologists or psychiatrists were associated with a significant increase in the likelihood of receiving ChEIs in the multivariate analysis. CONCLUSIONS: It seems that not age as such but the overall clinical condition of a patient including care dependency and geriatric comorbidities influences the process of decision making on prescription of ChEIs. SN - 1471-244X UR - https://www.unboundmedicine.com/medline/citation/22145796/Impact_of_geriatric_comorbidity_and_polypharmacy_on_cholinesterase_inhibitors_prescribing_in_dementia_ L2 - https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-190 DB - PRIME DP - Unbound Medicine ER -