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Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia

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...

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Autores principales: Hoffmann, Falk, van den Bussche, Hendrik, Wiese, Birgitt, Schön, Gerhard, Koller, Daniela, Eisele, Marion, Glaeske, Gerd, Scherer, Martin, Kaduszkiewicz, Hanna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262154/
https://www.ncbi.nlm.nih.gov/pubmed/22145796
http://dx.doi.org/10.1186/1471-244X-11-190
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author Hoffmann, Falk
van den Bussche, Hendrik
Wiese, Birgitt
Schön, Gerhard
Koller, Daniela
Eisele, Marion
Glaeske, Gerd
Scherer, Martin
Kaduszkiewicz, Hanna
author_facet Hoffmann, Falk
van den Bussche, Hendrik
Wiese, Birgitt
Schön, Gerhard
Koller, Daniela
Eisele, Marion
Glaeske, Gerd
Scherer, Martin
Kaduszkiewicz, Hanna
author_sort Hoffmann, Falk
collection PubMed
description 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.
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spelling pubmed-32621542012-01-20 Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia Hoffmann, Falk van den Bussche, Hendrik Wiese, Birgitt Schön, Gerhard Koller, Daniela Eisele, Marion Glaeske, Gerd Scherer, Martin Kaduszkiewicz, Hanna BMC Psychiatry Research Article 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. BioMed Central 2011-12-06 /pmc/articles/PMC3262154/ /pubmed/22145796 http://dx.doi.org/10.1186/1471-244X-11-190 Text en Copyright ©2011 Hoffmann et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Hoffmann, Falk
van den Bussche, Hendrik
Wiese, Birgitt
Schön, Gerhard
Koller, Daniela
Eisele, Marion
Glaeske, Gerd
Scherer, Martin
Kaduszkiewicz, Hanna
Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia
title Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia
title_full Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia
title_fullStr Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia
title_full_unstemmed Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia
title_short Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia
title_sort impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262154/
https://www.ncbi.nlm.nih.gov/pubmed/22145796
http://dx.doi.org/10.1186/1471-244X-11-190
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