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Use of dementia treatments is similar in community and long-term care settings

The prevalence of Alzheimer's disease and related dementias is much larger in long-term care facilities (57.2 percent) than in the community (5.1 percent), but similar proportions (about one-fourth) of both groups receive antidementia drugs, according to a new study.

Ann L. Gruber-Baldini, Ph.D., from The University of Maryland School of Medicine, and colleagues used the 2002 Medicare Current Beneficiary Survey to estimate the prevalence and use of antidementia drugs for treating Alzheimer's disease and dementia. Of the estimated 3.4 million Medicare beneficiaries with Alzheimer's disease and related dementias in 2002, nearly 60 percent lived in the community and approximately 40 percent resided in long-term care facilities.

Cholinesterase inhibitors, which are medications used to improve memory, judgment, and thought, are commonly prescribed to both community and long-term care residents with dementia. Donepezil, galantamine, and rivastigmine are the most common cholinesterase inhibitors and are prescribed fairly similarly to patients living in community (24.7 percent) and long-term care settings (26.3 percent).

The authors expected to find lower prescribing rates for these drugs in long-term care settings, because many patients with dementia in those facilities have severe symptoms, and the drugs were indicated at the time (2002) for mild to moderate symptoms. One explanation offered is that no drugs were available in 2002 for moderate to severe dementia, so clinicians were hesitant to remove patients from these medications without providing an alternative.

When dementia is accompanied by behavioral symptoms, such as agitation and combativeness, the antipsychotics olanzapine, quetiapine, and risperidone were sometimes prescribed, most often in long-term care than in community settings (11.9 vs. 4.0 percent, 7.1 vs. 2.3 percent, and 21 vs. 5.1 percent). Haloperidol, an antipsychotic that has serious side effects that include impaired control of movement, was seldom used.

The study was conducted by the University of Maryland DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Center and funded by the Agency for Healthcare Research and Quality (contract no. 290-2005-0039).

See "Treatment of dementia in community-dwelling and institutionalized Medicare beneficiaries," by Dr. Gruber-Baldini, Bruce Stuart, Ph.D., Ilene H. Zuckerman, Pharm. D., Ph.D., and others in the October 2007 Journal of the American Geriatric Society 55(10), pp. 1508-1516.

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