Deprescribing AChEIs in nursing home residents with dementia found safe

  • Niznik JD & al.
  • J Am Geriatr Soc
  • 26/11/2019

  • Susan London
  • Clinical Essentials
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Takeaway

  • Deprescribing acetylcholinesterase inhibitors (AChEIs) among nursing home residents with severe dementia did not increase risk for negative events and reduced risk for serious falls and fractures by 35%.

Why this matters

  • Lack of strong evidence supporting long-term AChEI therapy in this population, coupled with possible benefits of deprescribing to reduce medication burden, potential for adverse events.

Key results

  • 31.6% of residents experienced all-cause negative events.
  • Likelihood of these events with AChEIs deprescribing:
    • Increased in unadjusted model (OR, 1.17; P<.01>
    • Did not increase in fully adjusted model (aOR, 1.01; P=.94).
  • Deprescribing reduced likelihood of serious falls or fractures:
    • Unadjusted model (OR, 0.59; P<.001>
    • Adjusted model (aOR, 0.65; P<.001>
  • Similar findings in sensitivity analyses excluding patients in whom AChEIs were possibly restarted and regardless of baseline memantine use.

Study design

  • National cohort study using 2015-2016 Medicare claims and Nursing Home Compare data for 37,106 residents of nonskilled nursing homes aged ≥65 years with severe dementia receiving AChEIs.
  • Main outcome: all-cause negative events (emergency department visits, hospitalizations, deaths for any reason).
  • Funding: Patrick and Catherine Weldon Donaghue Medical Research Foundation; University of Pittsburgh Older American’s Independence Center.

Limitations

  • Potential misclassification.
  • Residual and unmeasured confounding.
  • Unknown generalizability.