Acetylcholinesterase inhibitors in assisted living: patterns of use and association with retention.
OBJECTIVE
To describe patterns of Acetylcholinesterase inhibitor (ACI) use in an Assisted Living (AL) population, and the association of ACIs with retention in AL.


METHODS
As part of the Maryland Assisted Living Study (MD-AL), 198 residents of 22 ALs were evaluated. Dementia was diagnosed in 134, and specifically Alzheimer's disease (AD) in 79, by an expert consensus panel. Data was collected on ACI agent and dose. Vital status and location were recorded every 6 months. Other data included age, duration of residence, general medical health rating (GHMR), Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD) and number of non-psychiatric medications.


RESULTS
The overall ACI treatment rate was 31%. 34.5% of participants with mild to moderate AD were taking ACIs. Only two in seven participants taking rivastigmine were taking an adequate dose. Participants with AD on ACI's did not differ significantly from those not on ACI's in any of the secondary measures except age and duration of residence, those on the agents being somewhat younger and more recently admitted. For participants with AD, only ACI use was significantly associated with retention in AL at 6 months, with a relative risk of death or discharge to higher level care of 0.217. Baseline MMSE was associated with retention for those with non-AD dementia. In a survival analysis ACI use was associated with 228.75 days longer retention in participants with AD.


CONCLUSIONS
ACIs have low rates of use in AL and are associated with better retention for residents with AD.
Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. arosenba@jhmi.edu
Adam
A
Rosenblatt
Quincy M
QM
Samus
Chiadi U
CU
Onyike
Alva S
AS
Baker
Matthew
M
McNabney
Lawrence S
LS
Mayer
Jason
J
Brandt
Constantine G
CG
Lyketsos
D000203:Activities of Daily Living; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000523:psychology; D040561:Assisted Living Facilities; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy / Q000523:psychology; D000077265:Donepezil; D004334:Drug Administration Schedule; D005260:Female; D005702:Galantamine / Q000627:therapeutic use; D006306:Health Surveys; D006707:Homes for the Aged; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D048448:Phenylcarbamates / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D012153:Retention, Psychology; D000068836:Rivastigmine; D016019:Survival Analysis; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors; D007189:Indans; D048448:Phenylcarbamates; D010880:Piperidines; D005702:Galantamine; D000077265:Donepezil; D000068836:Rivastigmine