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Topic Title

  • Methods for Studying Dementia Treatment and Outcomes in Observational Databases

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Methods for Studying Dementia Treatment and Outcomes in Observational Databases

Topic Abstract

Objectives: To establish nationally representative estimates of the use of agents to treat Alzheimer’s disease and related dementias (ADRD) and related behavioral symptoms among Medicare beneficiaries, and to describe medication use by residential status and other patient characteristics.

Design: Cross-sectional prevalence study.

Setting: Community-dwelling and various long-term care (LTC) settings.

Participants: 12,697 beneficiaries from the 2002 Medicare Current Beneficiary Survey (MCBS) of whom 11,593 were community dwelling and 1,104 resided in various LTC settings.

Measurements: ADRD was identified by ICD-9 codes in Medicare claims and self/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 ADRD (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 anti-dementia drugs was similar across settings, with 24.7% of dementia cases in the community and 26.3% of those in LTC receiving prescriptions for donepezil, galantamine, or rivistagmine. 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%).

Conclusion: The prevalence of ADRD in LTC settings is much larger than in the community, but there is little difference in the proportions receiving anti-dementia drugs across residential settings. However, LTC residents are more likely to be treated with atypical antipsychotics (risperidone, olanzapine, and quetiapine), presumably for behavioral symptoms.