Effect of Medications on Physical Function and Cognition in Nursing Home Residents with Dementia

Dutcher, Sarah K.; Rattinger, Gail B.; Langenberg, Patricia; Chhabra, Pankdeep; Liu, Xinggang; Rosenberg, Paul B.; Leoutsakos, Jeannie Marie S.; Simoni, Jane M.; Walker, Loreen; Franey, Christine; Zuckerman, Ilene H.

doi:10.1111/jgs.12838

Cited by 39 publications

(35 citation statements)

References 48 publications

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“…Recent findings on the association between antipsychotics and mood stabilizers and impairment on activities of daily living in older women suggest sex differences in response to psychotropic medication among older people with dementia living in NH [48]. In addition, it would be important to investigate whether the observed sex differences in the use of psychotropic medications are consistent over time.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Sex Differences in Psychotropic Medication Use in Older People with Alzheimer’s Disease in the US and Finland

et al. 2016

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Aims Given the high prevalence of psychotropic medication use in people with dementia and the potential for different prescribing practices in men and women, our study aimed to investigate sex differences in psychotropic medication use in older adults with Alzheimer's disease (AD) living in the US and Finland. Methods We used data collected between 2005 and 2011 as part of the National Alzheimer's Coordinating Center (NACC) in the US, and Medication use and Alzheimer's disease (MEDALZ) cohorts in Finland. We evaluated psychotropic medication use (antidepressant, antipsychotic, anxiolytic, sedative, or hypnotic) in participants aged 65 years or older. We employed multivariable logistic regression adjusted for demographics, co-morbidities, and other medications to estimate the magnitude of the association (adjusted odds ratio [aOR] with 95% confidence intervals [CIs]) according to sex. Results We included 1099 NACC participants (502 [45.68%] men, 597 [54.32%] women), and 67,049 participants from the MEDALZ cohort (22,961 [34.24%] men, 44,088 [65.75%] women). Women were more likely than men to use psychotropic medications: US, 46.2% vs. 33.1%, p < 0.001; Finland, 45.3% vs. 36.1%, p < 0.001; aOR was 2.06 (95% CI 1.58–2.70) in the US cohort and 1.38 (95% CI 1.33–1.43) in the Finnish cohort. Similarly, of the different psychotropic medications, women were more likely to use antidepressants (aOR-US: 2.16 [1.44–3.25], Finland: 1.52 [1.45–1.58]) and anxiolytics (aOR-US: 2.16 [1.83–3.96], Finland: 1.17 [1.13-1.23]) than men. Conclusionl Older women with AD are more likely to use psychotropic medications than older men, regardless of study population and country. Approaches to mitigate psychotropic medication use need to consider different prescribing habits observed in older women vs. men with AD.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Sex Differences in Psychotropic Medication Use in Older People with Alzheimer’s Disease in the US and Finland

et al. 2016

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“…4,5 Psychotropic medications are predominantly used in the management of BPSDs. 6,7 However, evidence demonstrates modest benefits of psychotropic medication for management of PWDs and a range of adverse outcomes. [8][9][10] With safety and efficacy issues surrounding the use of medications for the management of dementia symptoms, non-pharmacologic interventions are promoted in dementia care.…”

Section: Rationalementioning

confidence: 99%

“…While there are medications that slow cognitive decline, their effectiveness is limited . Psychotropic medications are predominantly used in the management of BPSDs . However, evidence demonstrates modest benefits of psychotropic medication for management of PWDs and a range of adverse outcomes .…”

Section: Introductionmentioning

confidence: 99%

Impact of individualised music listening intervention on persons with dementia: A systematic review of randomised controlled trials

et al. 2019

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Objective To summarise the evidence regarding the impact of individualised music listening on persons with dementia. Methods Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non–music‐based interventions. Results Four studies were included. Results showed evidence of a positive impact of individualised music listening on behavioural and psychological symptoms of dementia (BPSDs) including agitation, anxiety and depression and physiological outcomes. Evidence for other outcomes such as cognitive function and quality of life was limited. Conclusions The limited evidence suggests individualised music listening has comparable efficacy to more resource‐intensive interventions. However, there was a small number of RCTs and some outcomes were evaluated by a single study. This limits the conclusions drawn, warranting more RCTs evaluating other outcomes beyond the BPSDs.

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“…28 We used marginal structural models with inverse probability of treatment weights (IPTW) to address the potential for time-dependent confounding. [29][30][31][32][33][34] IPTWs were used to model each subject's propensity for being deprescribed, considering the subject's history of covariates. 30,35 We also addressed the potential for loss to follow-up by using inverse probability of censoring weights (IPCW), calculated as the probability of remaining uncensored at the time of each MDS assessment.…”

Section: Statistical Analysesmentioning

confidence: 99%

Risk for Health Events After Deprescribing Acetylcholinesterase Inhibitors in Nursing Home Residents With Severe Dementia

Niznik

Zhao

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVE Reevaluation of the appropriateness of acetylcholinesterase inhibitors (AChEIs) is recommended in older adults with severe dementia, given the lack of strong evidence to support their continued effectiveness and risk for medication‐induced adverse events. We sought to evaluate the impact of deprescribing AChEIs on risk of all‐cause events (hospitalizations, emergency department visits, and mortality) and serious falls or fractures in older nursing home (NH) residents with severe dementia. DESIGN Analysis of 2015 to 2016 data from Medicare claims, Part D prescriptions, Minimum Data Set (MDS) version 3.0, Area Health Resource File, and Nursing Home Compare. Marginal structural models with inverse probability of treatment weights were used to evaluate the association of deprescribing AChEIs and all‐cause negative events as well as serious falls or fractures. SETTING US Medicare‐certified NHs. PARTICIPANTS Nonskilled NH residents, aged 65 years and older, with severe dementia receiving AChEIs within the first 14 days of an MDS assessment in 2016 (n = 37 106). RESULTS The sample was primarily white (78.7%), female (75.5%), and aged 80 years or older (77.4%). Deprescribing AChEIs was associated with an increased likelihood of all‐cause negative events in unadjusted models (odds ratio [OR] = 1.17; 95% confidence interval [CI] = 1.11‐1.23; P < .01), but not in fully adjusted models (adjusted OR [aOR] = 1.00; 95% CI = 0.94‐1.06; P = .94). By contrast, deprescribing was associated with a reduced likelihood of serious falls or fractures in unadjusted models (OR = 0.59; 95% CI = 0.52‐0.66; P < .001) and remained significant in adjusted models (aOR = 0.64; 95% CI = 0.56‐0.73; P < .001). CONCLUSION Deprescribing AChEIs was not associated with a significant increase in the likelihood for all‐cause negative events and was associated with a reduced likelihood of falls and fractures in older NH residents with dementia. Our findings suggest that deprescribing AChEIs is a reasonable approach to reduce the risk of serious falls or fractures without increasing the risk for all‐cause events. J Am Geriatr Soc 68:699–707, 2020

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Effect of Medications on Physical Function and Cognition in Nursing Home Residents with Dementia

Cited by 39 publications

References 48 publications

A Comparison of Sex Differences in Psychotropic Medication Use in Older People with Alzheimer’s Disease in the US and Finland

A Comparison of Sex Differences in Psychotropic Medication Use in Older People with Alzheimer’s Disease in the US and Finland

Impact of individualised music listening intervention on persons with dementia: A systematic review of randomised controlled trials

Risk for Health Events After Deprescribing Acetylcholinesterase Inhibitors in Nursing Home Residents With Severe Dementia

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