Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2009 Dec;57(12):2269-74. doi: 10.1111/j.1532-5415.2009.02552.x. Epub 2009 Oct 26.
To determine the frequency of cholinesterase inhibitor (ChEI) use in nursing home (NH) residents with dementia and examine correlates of ChEI use in this population.
Cross-sectional study using the 2004 National Nursing Home Survey (NNHS).
A representative, stratified, random sample of U.S. NHs.
All NNHS participants aged 65 and older with a chart diagnosis of dementia.
Bivariate analyses to compare characteristics of NH residents with dementia according to ChEIs status and multivariable logistic regression to identify independent correlates of ChEI use.
Almost half (49.1%) of NNHS participants had dementia, and 30.0% of those with dementia were receiving ChEIs. Donepezil accounted for 71% of all ChEI prescriptions. Multivariable logistic regression showed that ChEI use was independently associated with younger age (odds ratio (OR)=0.42, 95% confidence interval (CI)=0.28-0.64, aged > or =95 vs 65-74), less activity of daily living impairment (OR=0.49, 95% CI=0.42-0.58, severe vs mild impairment), greater use of antipsychotics (OR=1.33, 95% CI=1.16-1.54) and antidepressants (OR=1.38, 95% CI=1.20-1.59), and residence in NHs with more beds (OR=1.52, 95% CI=1.07-2.16, > or =200 beds vs <50 beds).
Approximately 30% of NH residents with dementia in U.S. NHs are treated with ChEIs. Functional impairment and medical comorbidity are common in ChEIs users, although users tend to be younger and less impaired than NH residents with dementia who are not receiving ChEIs. Further study is required to determine the optimum use of ChEI in NH populations.
确定在患有痴呆症的养老院（NH）居民中使用胆碱酯酶抑制剂（ChEI）的频率，并检查该人群中使用 ChEI 的相关因素。
使用 2004 年全国养老院调查（NNHS）的横断面研究。
美国 NH 的代表性、分层、随机样本。
NNHS 中所有年龄在 65 岁及以上且有图表诊断为痴呆的参与者。
采用双变量分析比较根据 ChEI 状态的 NH 居民的特征，并采用多变量逻辑回归确定 ChEI 使用的独立相关因素。
NNHS 参与者中有近一半（49.1%）患有痴呆症，其中 30.0%的痴呆症患者正在服用 ChEI。多奈哌齐占所有 ChEI 处方的 71%。多变量逻辑回归显示，ChEI 使用与年龄较小（比值比（OR）=0.42，95%置信区间（CI）=0.28-0.64，年龄≥95 岁 vs 65-74 岁）、日常生活活动能力损伤较轻（OR=0.49，95%CI=0.42-0.58，严重 vs 轻度损伤）、更多使用抗精神病药（OR=1.33，95%CI=1.16-1.54）和抗抑郁药（OR=1.38，95%CI=1.20-1.59）以及居住在床位较多的 NH（OR=1.52，95%CI=1.07-2.16，≥200 张床位 vs <50 张床位）独立相关。
在美国 NH 中，约 30%的患有痴呆症的 NH 居民接受 ChEI 治疗。尽管使用 ChEI 的患者比未接受 ChEI 的痴呆症 NH 居民年龄更小，功能障碍程度更轻，但功能障碍和合并症很常见。需要进一步研究以确定在 NH 人群中使用 ChEI 的最佳方法。
