Original Study| Volume 12, ISSUE 9, P648-654, November 2011

Patterns of Dementia Treatment Use in Assisted Living Facilities: A Cross-Sectional Study of 1975 Demented Residents

Published:October 08, 2010DOI:


      To report the associated factors with the nonuse of cholinesterase-inhibitors and memantine in residents from assisted living (AL) facilities suffering from dementia.


      A cross-sectional study.


      The “Réseau de Recherche en Etablissement d’Hébergement pour Personnes Agées” (REHPA) network composed of 236 AL facilities in France.


      4896 residents randomly selected by birth date.


      A structured questionnaire was completed for each resident by the geriatricians of each AL facility. Demographics, medical history (including diagnosis of dementia), drugs (including specific dementia treatments), functional status and behavioral disturbances were collected. Multivariate linear regression analyses were performed.


      Among the 1975 suffering from dementia, 49.1% were not specifically treated. The independent associated factors to the nonuse of dementia treatment were an institutional length of stay longer than 3 years (OR = 1.62; 95% CI: 1.31–2.02), a transfer from a hospital (OR = 1.68; 95% CI: 1.33–2.11) or another institution (OR = 2.06; 95% CI: 1.45–2.93) before admission, being diagnosed by a specialist other than neurologist (GP: OR = 3.90; 95% CI: 2.58–5.89) (psychiatrist: OR = 1.88; 95% CI: 1.26–2.81) (geriatrician: OR = 1.42; 95% CI:1.08–1.87), a concomitant antipsychotic treatment (OR = 1.44; 95% CI: 1.13–1.82), the absence of behavioral disturbances (OR = 1.51; 95% CI: 1.14–2.01), and a higher degree of disability (OR = 2.16; 95% CI: 1.59–2.92).


      Nearly half of the dementia-affected residents were not specifically treated. The independent associated factors that have been identified in the study might bring light on the particular issues of dementia treatments in AL facilities.


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        • Small G.W.
        • Rabins P.V.
        • Barry P.P.
        • et al.
        Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatrics Society.
        JAMA. 1997; 278: 1363-1371
        • Hatoum H.T.
        • Thomas S.K.
        • Lin S.J.
        • et al.
        Predicting time to nursing home placement based on activities of daily living scores—a modelling analysis using data on Alzheimer’s disease patients receiving rivastigmine or donepezil.
        J Med Econ. 2009; 12: 98-103
        • Bernstein A.B.
        • Remsburg R.E.
        Estimated prevalence of people with cognitive impairment: Results from nationally representative community and institutional surveys.
        Gerontologist. 2007; 47: 350-354
        • Matthews F.E.
        • Dening T.U.K.
        Medical Research Council Cognitive Function and Ageing Study. Prevalence of dementia in institutional care.
        Lancet. 2002; 360: 225-226
        • Magaziner J.
        • German P.
        • Zimmerman S.
        • et al.
        The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: Diagnosis by expert panel.
        Gerontologist. 2000; 40: 663-672
        • Gruber-Baldini A.L.
        • Stuart B.
        • Zuckerman I.H.
        • et al.
        Treatment of dementia in community-dwelling and institutionalized Medicare beneficiaries.
        J Am Geriatr Soc. 2007; 55 (Erratum in: J Am Geriatr Soc 2007;55:1697): 1508-1516
        • Magaziner J.
        • Zimmerman S.
        • Gruber-Baldini A.L.
        • et al.
        Mortality and adverse health events in newly admitted nursing home residents with and without dementia.
        J Am Geriatr Soc. 2005; 53: 1858-1866
        • Ramaroson H.
        • Helmer C.
        • Barberger-Gateau P.
        • et al.
        Prevalence of dementia and Alzheimer’s disease among subjects aged 75 years or over: Updated results of the PAQUID cohort.
        Rev Neurol. 2003; 159: 405-411
        • Wachterman M.
        • Kiely D.K.
        • Mitchell S.L.
        Reporting dementia on the death certificates of nursing home residents dying with end-stage dementia.
        JAMA. 2008; 300: 2608-2610
        • Haute autorité de santé
        Diagnostic et prise en charge de la maladie d’Alzheimer et des maladies apparentées: Interventions médicamenteuses et non médicamenteuses.
        HAS. 2009; (Available at) (Accessed January 10, 2010)
        • Tariot P.N.
        • Cummings J.L.
        • Katz I.R.
        • et al.
        A randomized, double-blind, placebo-controlled study of the efficacy and safety of donepezil in patients with Alzheimer’s disease in the nursing home setting.
        J Am Geriatr Soc. 2001; 49: 1590-1599
        • Cummings J.L.
        • Mackell J.
        • Kaufer D.
        Behavioral effects of current Alzheimer’s disease treatments: A descriptive review.
        Alzheimers Dement. 2008; 4: 49-60
        • Winblad B.
        Donepezil in severe Alzheimer’s disease.
        Am J Alzheimers Dis Other Demen. 2009; 24: 185-192
        • Winblad B.
        • Kilander L.
        • Eriksson S.
        • et al.
        Donepezil in patients with severe Alzheimer’s disease: Double-blind, parallel-group, placebo-controlled study.
        Lancet. 2006; 367: 1057-1065
        • Jelic V.
        • Haglund A.
        • Kowalski J.
        • et al.
        Donepezil treatment of severe Alzheimer’s disease in nursing home settings. A responder analysis.
        Dement Geriatr Cogn Disord. 2008; 26: 458-466
        • Cummings J.L.
        • Koumaras B.
        • Chen M.
        • et al.
        Effects of Rivastigmine treatment on the neuropsychiatric and behavioral disturbances of nursing home residents with moderate to severe probable Alzheimer’s disease: A 26-week, multicenter, open-label study.
        Am J Geriatr Pharmacother. 2005; 3: 137-148
        • Aupperle P.M.
        • Koumaras B.
        • Chen M.
        • et al.
        Long-term effects of rivastigmine treatment on neuropsychiatric and behavioral disturbances in nursing home residents with moderate to severe Alzheimer’s disease: Results of a 52-week open-label study.
        Curr Med Res Opin. 2004; 20: 1605-1612
        • Winblad B.
        • Poritis N.
        Memantine in severe dementia: Results of the 9M-Best Study (Benefit and efficacy in severely demented patients during treatment with memantine).
        Int J Geriatr Psychiatry. 1999; 14: 135-146
        • Winblad B.
        • Wimo A.
        • Engedal K.
        • et al.
        3-year study of donepezil therapy in Alzheimer’s disease: Effects of early and continuous therapy.
        Dement Geriatr Cogn Disord. 2006; 21: 353-363
        • Zarowitz B.J.
        • Stefanacci R.
        • Hollenack K.
        • et al.
        The application of evidence-based principles of care in older persons (issue 5): Alzheimer’s disease.
        J Am Med Dir Assoc. 2007; 8: 183-193
        • Vantelon C.
        • Gilbert S.
        • Kerneis S.
        • et al.
        Cholinesterase inhibitor therapy in long-term care settings.
        Rev Med Interne. 2006; 27: 588-594
        • Smith D.A.
        Treatment of Alzheimer’s disease in the long-term-care setting.
        Am J Health Syst Pharm. 2009; 66: 899-907
        • Seitz D.P.
        • Gruneir A.
        • Conn D.K.
        • et al.
        Cholinesterase inhibitor use in US nursing homes: Results from the national nursing home survey.
        J Am Geriatr Soc. 2009; 57: 2269-2274
        • Pedone C.
        • Lapane K.L.
        • Mor V.
        • et al.
        Donepezil use in US nursing homes.
        Aging Clin Exp Res. 2004; 16: 60-67
        • Rolland Y.
        • Abellan van Kan G.
        • Hermabessiere S.
        • et al.
        Descriptive study of nursing home residents from the REHPA network.
        J Nutr Health Aging. 2009; 13: 679-683
        • Charlson M.
        • Szatrowski T.P.
        • Peterson J.
        • et al.
        Validation of a combined comorbidity index.
        J Clin Epidemiol. 1994; 47 (1245–125)
        • Katz S.
        • Ford A.B.
        • Moskowitz R.W.
        • et al.
        Studies of illness in the aged. The index of ADL. A standardized measure of biological and psychological function.
        JAMA. 1963; 185: 914-919
        • Herrmann N.
        • Gill S.S.
        • Bell C.M.
        • et al.
        A population-based study of cholinesterase inhibitor use for dementia.
        J Am Geriatr Soc. 2007; 55: 1517-1523
        • Mamdani M.
        • Rapoport M.
        • Shulman K.I.
        • et al.
        Mental health-related drug utilization among older adults: Prevalence, trends, and costs.
        Am J Geriatr Psychiatry. 2005; 13: 892-900
        • Rodda J.
        • Morgan S.
        • Walker Z.
        Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer’s disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine.
        Int Psychogeriatr. 2009; 21: 813-824
        • Wang P.S.
        • Schneeweiss S.
        • Avorn J.
        • et al.
        Risk of death in elderly users of conventional vs. atypical antipsychotic medications.
        N Engl J Med. 2005; 353: 2335-2341
        • Formiga F.
        • Fort I.
        • Robles M.J.
        • et al.
        Lower barthel index scores predict less prescription of pharmacological therapy in elderly patients with Alzheimer disease.
        Dement Geriatr Cogn Disord. 2010; 29: 198-203
        • Dybicz S.B.
        • Keohane D.J.
        • Erwin W.G.
        • et al.
        Patterns of cholinesterase-inhibitor use in the nursing home setting: A retrospective analysis.
        Am J Geriatr Pharmacother. 2006; 4: 154-160
      1. Food and Drug Administration. FDA approves expanded use of treatment for patients with severe Alzheimer’s disease. Available at: Accessed January 10, 2010.

        • Delagarza V.W.
        Pharmacologic treatment of Alzheimer’s disease: An update.
        Am Fam Physician. 2003; 68: 1365-1372
        • Lee J.
        • Monette J.
        • Sourial N.
        • et al.
        The use of a cholinesterase inhibitor review committee in long-term care.
        J Am Med Dir Assoc. 2007; 8: 243-247
        • Birks J.
        Cholinesterase inhibitors for Alzheimer’s disease.
        Cochrane Database Syst Rev. 2006; (CD005593)
        • Wild R.
        • Pettit T.
        • Burns A.
        Cholinesterase inhibitors for dementia with Lewy bodies.
        Cochrane Database Syst Rev. 2003; (CD003672)
        • Maidment I.
        • Fox C.
        • Boustani M.
        Cholinesterase inhibitors for Parkinson’s disease dementia.
        Cochrane Database Syst Rev. 2006; (CD004747)
      2. Food and Drug Administration. FDA approves the first treatment for dementia of Parkinson’s disease. Available at: Accessed January 10, 2010.

        • O’Brien J.A.
        • Caro J.J.
        Alzheimer’s disease and other dementia in nursing homes: Levels of management and cost.
        Int Psychogeriatr. 2001; 13: 347-358
        • Bernabei R.
        • Gambassi G.
        • Lapane K.
        • et al.
        Characteristics of the SAGE database: A new resource for research on outcomes in long-term care. SAGE (Systematic Assessment of Geriatric drug use via Epidemiology) Study Group.
        J Gerontol A Biol Sci Med Sci. 1999; 54: 25-33