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Journal Article

Citation

Niznik JD, Zhao X, He M, Aspinall SL, Hanlon JT, Nace D, Thorpe JM, Thorpe CT. Alzheimers Dement. 2020; ePub(ePub): ePub.

Affiliation

University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA.

Copyright

(Copyright © 2020, Alzheimer's Association, Publisher Elsevier Publishing)

DOI

10.1002/alz.12054

PMID

32052930

Abstract

INTRODUCTION: We evaluated the impact of deprescribing acetylcholinesterase inhibitors (AChEIs) on aggressive behaviors and incident antipsychotic use in nursing home (NH) residents with severe dementia.

METHODS: We conducted a retrospective study of Medicare claims, Part D, Minimum Data Set for NH residents aged 65+ with severe dementia receiving AChEIs in 2016. Aggressive behaviors were measured using the aggressive behavior scale (ABS; n = 30,788). Incident antipsychotic prescriptions were evaluated among antipsychotic non-users (n = 25,188). Marginal structural models and inverse probability of treatment weights were used to evaluate associations of AChEI deprescribing and outcomes.

RESULTS: The severity of aggressive behaviors was low at baseline (mean ABS = 0.5) and was not associated with deprescribing AChEIs (0.002 increase in ABS, P =.90). Incident antipsychotic prescribing occurred in 5.1% of residents and was less likely with AChEI deprescribing (adjusted odds ratio = 0.52 [0.40-0.68], P <.001]).

DISCUSSION: Deprescribing AChEIs was not associated with a worsening of aggressive behaviors or incident antipsychotic prescriptions.

© 2020 the Alzheimer's Association.


Language: en

Keywords

Medicare; cholinesterase inhibitor; dementia; deprescribing; long term care; nursing home; pharmacoepidemiology

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