title: Cholinesterase inhibitors do not alter the length of stay in nursing homes among patients with Alzheimer's disease: a prospective, observational study of factors affecting survival time from admission to death.
abstract: BACKGROUND
  The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by sociodemographic/clinical characteristics, rate of disease progression, and use of specific medications and community-based services. Whether different aspects of cholinesterase inhibitor (ChEI) therapy modify time spent in NHs is unclear. Therefore, we examined the relationship between these potential predictors and survival time in NHs.
  
  
  METHODS
  This prospective, multicenter study of ChEI treatment in clinical practice included 220 deceased patients clinically diagnosed with mild-to-moderate AD who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) performance, ChEI dose, and amount of services used/week were evaluated every 6 months over 3 years. Dates of nursing-home placement (NHP) and death were recorded. Variables that determined survival time in NHs were analyzed using general linear models.
  
  
  RESULTS
  The mean survival time in NHs was 4.06 years (men, 2.78 years; women, 4.53 years; P < 0.001). The multivariate model showed that a shorter stay in NHs was associated with the interaction term male living with a family member, use of antihypertensive/cardiac therapy or anxiolytics/sedatives/hypnotics, and worse basic ADL at NHP, but not with age or cognitive and instrumental ADL capacities.
  
  
  CONCLUSIONS
  Increased community-based care did not reduce the survival time in NHs among individuals with AD. Men living with family spent significantly less time in NHs compared with the corresponding women, which suggests that the situation of female spouses of AD patients may need attention and possibly support. There was no indication that different aspects of ChEI therapy, e.g., drug type, dose, or duration, alter survival time in NHs.
authors: Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden. carina.wattmo@skane.se.|Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden. carina.wattmo@skane.se.
authors: Carina
authors: C
authors: Wattmo
authors: Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden.|Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden.
authors: Elisabet
authors: E
authors: Londos
authors: Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden.|Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden.
authors: Lennart
authors: L
authors: Minthon
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000401:mortality*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D009735:Nursing Homes; D011446:Prospective Studies; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology
chemical_list: D002800:Cholinesterase Inhibitors
keywords: Activities of daily living; Alzheimer’s disease; Cholinesterase inhibitors; Cognition; Community-based services; Longitudinal study; Predictors; Sex; Survival time in nursing homes