CHOLINESTERASE INHIBITOR THERAPY DOES NOT AFFECT TIME SPENT IN NURSING HOMES IN PATIENTS WITH ALZHEIMER'S DISEASE

Abstract

Background: The time spent in nursing homes (NHs) by patients with Alzheimer’s disease (AD) might be influenced by many factors, e.g., sociodemographic and clinical characteristics, rate of disease progression, and concomitant disorders. Whether different aspects of cholinesterase inhibitor (ChEI) therapy (drug agent, dose, and duration) affect time spent in NHs has not been investigated. We studied the relationship between these potential predictors and time spent in NHs. Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study for the long-term assessment of ChEI therapy in a routine clinical setting. This presentation includes 220 deceased SATS participants clinically diagnosed with mild-to-moderate AD (Mini-Mental State Examination score, 10–26 at the start of ChEI treatment) who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) capacities were evaluated at the baseline and semiannually over 3 years. The dates of nursing home placement (NHP) and death were recorded. Variables that determined time spent in NHs were analyzed using general linear models. Results: The mean (95% confidence interval) time spent in NHs was 4.06 (3.69–4.43) years: 2.78 (2.19–3.38) years for men vs 4.53 (4.09–4.96) years for women; P < 0.001. When considering the interaction effect of sex and living status, males living with a family member spent a shorter time in NHs (2.15 (1.48–2.83) years) vs the other groups: females living with family, 4.75 (4.00–5.50) years; males living alone, 4.00 (2.96–5.05) years; and females living alone, 4.41 (3.87–4.95) years; P < 0.001. The multivariate model showed that a shorter stay in NHs was independently related to being a man living with family, lower basic ADL at NHP, and more concomitant medications. Age, cognitive or instrumental ADL capacities at NHP, rates of decline in cognition or function, and ChEI type, dose, and treatment duration were not significant predictors. Conclusions: Women cared for their spouses with AD at home longer than did men. The situation of these female informal caregivers needs attention and possibly support. There was no indication that any aspects of ChEI therapy influenced the time spent in NHs.