- 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.
- 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).
- Unadjusted model (OR, 0.59; P<.001>
- Adjusted model (aOR, 0.65; P<.001>
- 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.
- Potential misclassification.
- Residual and unmeasured confounding.
- Unknown generalizability.