Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia

BMC Psychiatry

Research Article

Birgitt Wiese¹  Gerhard Schön²  Hanna Kaduszkiewicz³  Marion Eisele³  Martin Scherer³  Hendrik van den Bussche³  Daniela Koller⁴  Falk Hoffmann⁴  Gerd Glaeske⁴ 

[1] Institute of Biometrics, Hannover Medical School, Germany;Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany;Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany;University of Bremen, Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, Bremen, Germany;

关键词: Dementia;    Cholinesterase Inhibitor;    Geriatric Patient;    Rivastigmine;    Galantamine;   

DOI  :  10.1186/1471-244X-11-190

 received in 2011-08-19, accepted in 2011-12-06,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundAlthough most guidelines recommend the use of cholinesterase inhibitors (ChEIs) for mild to moderate Alzheimer's Disease, only a small proportion of affected patients receive these drugs. We aimed to study if geriatric comorbidity and polypharmacy influence the prescription of ChEIs in patients with dementia in Germany.MethodsWe used claims data of 1,848 incident patients with dementia aged 65 years and older. Inclusion criteria were first outpatient diagnoses for dementia in at least three of four consecutive quarters (incidence year). Our dependent variable was the prescription of at least one ChEI in the incidence year. Main independent variables were polypharmacy (defined as the number of prescribed medications categorized into quartiles) and measures of geriatric comorbidity (levels of care dependency and 14 symptom complexes characterizing geriatric patients). Data were analyzed by multivariate logistic regression.ResultsOn average, patients were 78.7 years old (47.6% female) and received 9.7 different medications (interquartile range: 6-13). 44.4% were assigned to one of three care levels and virtually all patients (92.0%) had at least one symptom complex characterizing geriatric patients. 13.0% received at least one ChEI within the incidence year. Patients not assigned to the highest care level were more likely to receive a prescription (e.g., no level of care dependency vs. level 3: adjusted Odds Ratio [OR]: 5.35; 95% CI: 1.61-17.81). The chance decreased with increasing numbers of symptoms characterizing geriatric patients (e.g., 0 vs. 5+ geriatric complexes: OR: 4.23; 95% CI: 2.06-8.69). The overall number of prescribed medications had no influence on ChEI prescription and a significant effect of age could only be found in the univariate analysis. Living in a rural compared to an urban environment and contacts to neurologists or psychiatrists were associated with a significant increase in the likelihood of receiving ChEIs in the multivariate analysis.ConclusionsIt seems that not age as such but the overall clinical condition of a patient including care dependency and geriatric comorbidities influences the process of decision making on prescription of ChEIs.

【 授权许可】

CC BY   
© Hoffmann et al; licensee BioMed Central Ltd. 2011