Treatment of dementia in community-dwelling and institutionalized medicare beneficiaries.
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.
Gruber-Baldini
Ann L
AL
Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Pharmacy, Baltimore, Maryland 21201, USA. abaldin@epi.umaryland.edu
Stuart
Bruce
B
Zuckerman
Ilene H
IH
Simoni-Wastila
Linda
L
Miller
Ram
R
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
D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors