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Use of anti-dementia drugs and delayed care home placement: an observational study

  • Emad Salib (a1) and Jessica Thompson (a2)
Abstract
Aims and method

To examine the association between the use of cholinesterase inhibitors (ChEIs) and time to care home placement. We compared patients who were prescribed ChEIs in 2006 with those who were not with respect to their placement in care homes over a 4-year period, using survival analysis.

Results

During the first 30 months of follow-up there was a delay in care home placement by a median of 12 months in those who took ChEIs compared with those who did not. However, at the end of the follow-up there was no significant reduction in the probability of being in a care home setting between those who had taken ChEIs compared with those who had not (hazard ratio 0.75, 95% CI 0.25–6, P = 0.1).

Clinical implications

The study provides some evidence to suggest that prescribing ChEIs may be associated with a delay in the timing of care home placement as observed in the first 2.5 years of treatment. However, based on purely observational data, no conclusion can be made as to whether such association is causal.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Emad Salib (esalib@hotmail.com)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Lopez, OL, Becker, JT, Wahed, AS, Saxton, J, Sweet, R, Wolk, D, et al. Long-term effects of the contaminant use of memantine with cholinesterase inhibition in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2009; 80: 600–7.
2 Feldman, HH, Pirttila, T, Dartigues, JF, Everitt, B, Van Baelen, B, Schwalen, S, et al. Treatment with galantamine and time to nursing home placement in Alzheimer's disease patients with and without cerebrovascular disease. Int J Ger Psychiatry 2009; 24: 479–88.
3 Geldmacher, DS, Provenzano, G, McRae, T, Mastey, V, Ieni, JR. Donepezil is associated with delayed nursing home placement in patients with Alzheimer's disease. J Am Ger Soc 2003; 51: 937–44.
4 Lopez, OL, Becker, JT, Wisniewski, S, Kaufer, D, DeKosky, ST. Cholinesterase inhibitor treatment alters the natural history of Alzheimer's disease. J Neurol Neurosurg Psychiatry 2002; 72: 310–4.
5 National Institute for Health and Clinical Excellence. Alzheimer's Disease – Donepezil, Galantamine, Rivastigmine and Memantine (Review): Appraisal Consultation Document. NICE, 2010 (http://www.nice.org.uk/guidance/index.jsp?action=article&o=51047).
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7 Cohen, CA, Gold, DP, Shulman, KI, Woetley, JT, McDonald, G, Wargon, M. Factors determining the decision to institutionalise dementing individuals: a prospective study. Gerontologist 1993; 33: 714–20.
8 Hope, T, Keene, J, Gelding, K, Fairburn, C, Jacoby, R. Predictors of institutionalisation for people with dementia living at home with a carer. Int J Ger Psychiatry 1998; 13: 682–90.
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10 Karlawish, JH, Klocinski, JL, Merz, J, Clark, CM, Asch, DA. Caregiver's preferences for the treatment of patients with Alzheimer's disease. Neurology 2000; 55: 1008–14.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Use of anti-dementia drugs and delayed care home placement: an observational study

  • Emad Salib (a1) and Jessica Thompson (a2)
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