BACKGROUND Antidementia medication can provide symptomatic improvements in patients with Alzheimer's disease, but there is a lack of consensus guidance on when to start and stop treatment in the nursing home setting. METHODS We describe utilization patterns of cholinesterase inhibitors (ChEI) and memantine for 3,50,197 newly admitted NH residents with dementia between 2011 and 2018. RESULTS Overall, pre-admission use of antidementia medications declined from 2011 to 2018 (ChEIs: 44.5% to 36.9%; memantine: 27.4% to 23.2%). Older age, use of a feeding tube, and greater functional dependency were associated with lower odds of ChEI initiation. Coronary artery disease, parenteral nutrition, severe aggressive behaviors, severe cognitive impairment, and high functional dependency were associated with discontinuation of ChEIs. Comparison of clinical factors related to anti-dementia drug treatment changes from pre to post NH admission in 2011 and 2018 revealed a change toward lower likelihood of initiation of treatment among residents with more functional dependency and those with indicators of more complex illness as well as a change toward higher likelihood of discontinuation in residents having 2 or more hospital stays. CONCLUSIONS These prescribing trends highlight the need for additional research on the effects of initiating and discontinuing antidementia medications in the NH to provide clear guidance for clinicians when making treatment decisions for individual residents.

中文翻译：

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疗养院居民抗痴呆药物的使用。

背景抗痴呆药物可以改善阿尔茨海默病患者的症状，但在疗养院环境中何时开始和停止治疗缺乏共识指导。方法 我们描述了 2011 年至 2018 年间 3,50,197 名新入院的痴呆症新罕布什尔州居民的胆碱酯酶抑制剂 (ChEI) 和美金刚的使用模式。 结果 总体而言，从 2011 年到 2018 年，入院前抗痴呆药物的使用有所下降（ChEI：44.5% 至 36.9%） %；美金刚：27.4%至23.2%)。年龄较大、使用饲管和较大的功能依赖性与 ChEI 启动几率较低相关。冠状动脉疾病、肠外营养、严重攻击行为、严重认知障碍和高度功能依赖性与 ChEI 的终止相关。比较 2011 年和 2018 年 NH 入院前与入院后抗痴呆药物治疗变化相关的临床因素，发现功能依赖程度较高的居民和患有更复杂疾病指标的居民开始治疗的可能性较低。住院 2 次或以上的居民中止治疗的可能性更高。结论 这些处方趋势强调需要对新罕布什尔州开始和停止抗痴呆药物的影响进行更多研究，以便为临床医生为个体居民做出治疗决策时提供明确的指导。