title: Treatment of dementia in community-dwelling and institutionalized medicare beneficiaries.
abstract: OBJECTIVE
  To establish nationally representative estimates of the use of agents to treat Alzheimer's disease and related dementias (ADRDs) and related behavioral symptoms in Medicare beneficiaries and to describe medication use according to residential status and other patient characteristics.
  
  
  METHODS
  Cross-sectional prevalence study.
  
  
  METHODS
  Community and various long-term care (LTC) settings.
  
  
  METHODS
  Twelve thousand six hundred ninety-seven beneficiaries from the 2002 Medicare Current Beneficiary Survey (MCBS), of whom 11,593 were community dwelling and 1,104 resided in various LTC settings.
  
  
  METHODS
  ADRDs were identified according to International Classification of Diseases, Ninth Revision, codes in Medicare claims and self- and proxy reports. Medication use was derived from self-reports (community) and extracts of facility medication administration records (LTC).
  
  
  RESULTS
  In 2002, an estimated 3.4 million Medicare beneficiaries were diagnosed with ADRDs (8.1%), of whom 58.9% resided in the community (prevalence rate=5.1%) and 41.1% resided in LTC facilities (prevalence rate=57.2%). Use of antidementia drugs was similar across settings, with 24.7% of subjects with dementia in the community and 26.3% of those in LTC receiving prescriptions for donepezil, galantamine, or rivastigmine. Use of haloperidol was comparable (and low) in both settings. Use of atypical antipsychotics, especially risperidone, olanzapine, and quetiapine, was much higher in LTC residents (21.0%, 11.9%, and 7.1%, respectively) than in the community (5.1%, 4.0%, and 2.3%).
  
  
  CONCLUSIONS
  The prevalence of ADRDs in LTC settings is much larger than in the community, but there is little difference in the proportions receiving antidementia drugs, although LTC residents are more likely to be treated with atypical antipsychotics (risperidone, olanzapine, and quetiapine), presumably for behavioral symptoms.
authors.affiliation: Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Pharmacy, Baltimore, Maryland 21201, USA. abaldin@epi.umaryland.edu
authors.forename: Ann L
authors.initials: AL
authors.lastname: Gruber-Baldini
authors.forename: Bruce
authors.initials: B
authors.lastname: Stuart
authors.forename: Ilene H
authors.initials: IH
authors.lastname: Zuckerman
authors.forename: Linda
authors.initials: L
authors.lastname: Simoni-Wastila
authors.forename: Ram
authors.initials: R
authors.lastname: Miller
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000145:classification / Q000188:drug therapy* / Q000453:epidemiology; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003704:Dementia / Q000145:classification / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007326:Institutionalization; D008134:Long-Term Care; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D014481:United States
chemical_list: D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors