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Treated Behavioral Symptoms and Mortality in Medicare Beneficiaries in Nursing Homes with Alzheimer's Disease and Related Dementias
Author(s) -
Huang TingYing,
Wei YuJung,
Moyo Patience,
Harris Ilene,
Lucas Judith A.,
SimoniWastila Linda
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13606
Subject(s) - medicine , hazard ratio , minimum data set , cohort , dementia , confidence interval , medical prescription , retrospective cohort study , activities of daily living , antipsychotic , disease , cohort study , psychiatry , nursing homes , schizophrenia (object oriented programming) , nursing , pharmacology
Objectives To assess changes in behavioral symptoms associated with Alzheimer's disease and related dementias ( ADRD s) after antipsychotic ( AP ) or antidepressant ( AD ) treatment and to estimate the effect of treatment response on mortality risk. Design Retrospective cohort study using 2006–2009 Medicare administrative and prescription drug claims data linked to Minimum Data Set 2.0. Setting Long‐stay (≥101 days) nursing home residents. Participants Continuously enrolled fee‐for‐service Medicare beneficiaries who had ADRD s, initiated (no use in prior 6 months) AP (n = 2,035) or AD (n = 1,661) treatment during or after one or more behavioral symptoms (verbally abusive, physically abusive, socially inappropriate or disruptive behavior) presented, and had reassessment of behavioral symptoms after 3 consecutive months of the initiated treatment. Measurements Behavioral symptom change was measured according to score (range 0–9, based on number and frequency of symptoms) change between baseline and reassessment (improved, <0; unchanged, 0; worsened, >0). Survival analyses were conducted on time to death after reassessment, comparing residents whose symptoms improved with those whose symptoms remained unchanged or worsened. Results AP s and AD s were comparable in treatment effectiveness, as evidenced by more than 85% of the behavioral symptom episodes in each cohort improving or remaining stable. Mortality risk was lower in both cohorts ( AP : adjusted hazard ratio ( aHR AP ) = 0.93, 95% confidence interval ( CI ) = 0.81–1.07; AD : aHR AD = 0.82, 95% CI = 0.70–0.97) for residents whose symptoms improved than for those whose symptoms unchanged or worsened. Conclusion AD s may be reasonable pharmacological alternatives to AP s in clinical management of ADRD ‐related behavioral symptoms. Initial treatment response may alter medication‐associated mortality risk. Further study is needed to confirm findings using other data and behavioral symptom–specific instruments.