The Use of a Cholinesterase Inhibitor Review Committee in Long-Term Care

Lee, Joyce; Monette, Johanne; Sourial, Nadia; Monette, Michele; Bergman, Howard

doi:10.1016/j.jamda.2007.02.007

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Volume 8, Issue 4 , Pages 243-247, May 2007

The Use of a Cholinesterase Inhibitor Review Committee in Long-Term Care

Joyce Lee, MD, BScPhm
- Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Canada
- Solidage, McGill/Université de Montréal Research Group on Services for Older Persons, Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Address correspondence to Joyce Lee, MD, BScPhm, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada.
Johanne Monette, MD, MSc
- Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Canada
- Solidage, McGill/Université de Montréal Research Group on Services for Older Persons, Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
Nadia Sourial, MSc
- Solidage, McGill/Université de Montréal Research Group on Services for Older Persons, Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
Michele Monette, OT, MSc
- Solidage, McGill/Université de Montréal Research Group on Services for Older Persons, Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
- Maimonides Geriatric Centre, McGill University, Montreal, Canada.
Howard Bergman, MD
- Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Canada
- Solidage, McGill/Université de Montréal Research Group on Services for Older Persons, Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada

Objective

The objective of the study was to document the effectiveness of a Cholinesterase Inhibitor (ChE-I) Review Committee in a long-term care (LTC) institution in Montreal, Canada.

Design

Retrospective cohort study.

Setting

Maimonides Geriatric Centre (MGC), a 387-bed LTC facility in Montreal, Canada, in which 352 patients have dementia.

Participants

Fifty-two patients on ChE-I who were reviewed at least once by the ChE-I Review Committee between January and November 2005.

Measurements

Recommendations for discontinuation, actual discontinuation, and restarting of ChE-I, along with reasons underlying these decisions, were collected from the patients’ charts over a 4-month period following Review Committee assessment.

Results

The Review Committee recommended discontinuation of ChE-I in 17 (32.7%) of the 52 patients. After 1 patient died and therefore was excluded from the study, 13 (81.3%) of the remaining 16 were actually discontinued. The most common reasons for recommendation to discontinue ChE-I were insufficient benefit on cognition, activities of daily living (ADL), and behavior. Subsequently, ChE-I was resumed in 4 (30.8%) of the 13 patients discontinued, 2 because of ADL deterioration and 2 at the request of the family.

Conclusions

Through the review process, almost one third of ChE-I users were recommended for discontinuation because of insufficient benefit; the majority of these were discontinued. Fewer than one third were subsequently restarted. A ChE-I Review Committee seemed to be an effective and acceptable model for decision making regarding ChE-I use in LTC.

Keywords: Cholinesterase inhibitors, long-term care, dementia, Alzheimer disease, discontinuation, review committee