Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
J Am Geriatr Soc. 2020 Dec;68(12):2797-2804. doi: 10.1111/jgs.16776. Epub 2020 Aug 15.
To investigate the time course of anticholinergic drug use in nursing home residents and assess if any temporal change in anticholinergic use varied by nursing home quality rating.
Retrospective repeated cross-sectional analysis of Medicare enrollment, Parts A, B, and D, claims data linked to the Minimum Data Set from 2009 to 2017.
Medicare-certified nursing homes.
Long-term residents 65 years or older with nursing home stay of at least 100 consecutive days within a given calendar year.
Estimates of anticholinergic drug prescription rates between 2009 and 2017 were based on a binary variable indicating whether a resident received a drug with high anticholinergic activity, as defined by the Anticholinergic Cognitive Burden scale, for at least 1 day during the initial 100 consecutive days of nursing home stay in a given calendar year. We used mixed effects logistic regression models to determine adjusted rates of anticholinergic use each year and test the interaction between nursing home quality rating and year, while adjusting for patient and nursing home characteristics.
The cohort included 786,858 100-day nursing home stays (299,354 unique residents) in 6,703 nursing homes for the years 2009 to 2017. Prescription rates were stable at approximately 34% to 35% between 2009 and 2011, then gradually decreased to 24.3% in 2017 (P < .0001), with the decline being more pronounced in nursing homes having high quality ratings (P < .0001). Rates for anticholinergic drugs in nursing homes with 4 to 5 star quality rating (33.7% in 2011 to 23.3% in 2017) showed a steeper decline over time relative to nursing homes with 1 to 2 star quality rating (34.2% in 2011 to 25.2% in 2017) (P < .0001).
The use of drugs with high anticholinergic activity has declined from 2009 to 2017, with a greater decline in higher-quality nursing homes.
调查养老院居民中抗胆碱能药物使用的时间进程，并评估抗胆碱能药物使用是否存在任何随时间的变化，且这种变化是否因养老院质量评分而异。
对 2009 年至 2017 年医疗保险参保人员 A、B 和 D 部分的入组、医疗保险登记、护理记录进行回顾性重复横断面分析，并与最低数据集进行链接。
经认证的养老院。
65 岁或以上的长期居民，在给定的日历年中，在养老院至少连续居住 100 天。
根据 2009 年至 2017 年的二进制变量，估计抗胆碱能药物的处方率，该变量表示居民在给定的日历年中，在养老院连续居住的最初 100 天内，至少有一天服用了一种具有高抗胆碱能活性的药物，这种药物是根据抗胆碱能认知负担量表来定义的。我们使用混合效应逻辑回归模型来确定每年调整后的抗胆碱能药物使用率，并测试养老院质量评分与年份之间的交互作用，同时调整患者和养老院的特征。
该队列包括 2009 年至 2017 年期间在 6703 家养老院中进行的 786858 次 100 天的养老院入住（299354 名独特的居民）。2009 年至 2011 年，处方率稳定在 34%至 35%之间，然后逐渐下降到 2017 年的 24.3%（P < 0.0001），在质量评分较高的养老院中下降更为明显（P < 0.0001）。在质量评分 4 至 5 星级的养老院（2011 年为 33.7%，2017 年为 23.3%）中，与质量评分 1 至 2 星级的养老院（2011 年为 34.2%，2017 年为 25.2%）相比，抗胆碱能药物的使用率随时间呈现出更陡峭的下降趋势（P < 0.0001）。
自 2009 年至 2017 年，具有高抗胆碱能活性的药物的使用有所下降，在高质量的养老院中下降更为明显。
