Acetylcholinesterase inhibitor and N-methyl-D-aspartic acid receptor antagonist use among hospice enrollees with a primary diagnosis of dementia.
OBJECTIVE
To describe acetylcholinesterase inhibitor (AChEI) and memantine use among persons over the age of 65 admitted to hospice with a primary diagnosis of dementia and identify patient and hospice program characteristics associated with the use of these agents.


METHODS
Retrospective, cross-sectional study.


METHODS
Administrative database of a national hospice pharmacy provider.


METHODS
A total of 10,065 persons with end-stage dementia admitted to one of 441 U.S. hospices in 2004.


METHODS
The frequency of AChEI and memantine use was determined and utilized as the unit of analysis for bivariate and multivariate comparisons with patient and hospice program characteristics.


RESULTS
Twenty-one percent (2148/10,065) of patients were prescribed AChEI and/or memantine therapy at the time of hospice enrollment. Of these, 49.5% were prescribed donepezil. Odds of receiving AChEI and/or memantine therapy were less likely if the patient was female, (odds ratio [OR] 0.68, 0.62-0.76), died while enrolled in hospice (OR 0.75, 0.67-0.85), received care at home (0.80, 0.71-0.89), or had a hospice length of stay (LOS) less than 7 days (0.53, 0.45-0.62). Patients who had a LOS of at least 60 days were significantly more likely to have received such therapies (OR 1.41 [1.24-1.60] for 61-180 days and 1.33 [1.15-1.54] for over 180 days).


CONCLUSIONS
A notable number of hospice enrollees with a primary diagnosis of dementia were prescribed AChEI and/or NMDA receptor antagonist therapy. Studies are needed to better define the role of these agents as well as the impact of medication discontinuation in persons with end-stage dementia.
Weschules
Douglas J
DJ
GlaxoSmithKline, Philadelphia, Pennsylvania 19101, USA. douglas.j.weschules@gsk.com
Maxwell
Terri L
TL
Shega
Joseph W
JW
D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D006738:Hospices; D006801:Humans; D008297:Male; D008875:Middle Aged; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D014481:United States
D002800:Cholinesterase Inhibitors; D016194:Receptors, N-Methyl-D-Aspartate