Treatment of Dementia in Community-Dwelling and Institutionalized Medicare Beneficiaries

Authors

  • Ann L. Gruber-Baldini PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine, and Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, Maryland.
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  • Bruce Stuart PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine, and Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, Maryland.
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  • Ilene H. Zuckerman Pharm D, PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine, and Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, Maryland.
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  • Linda Simoni-Wastila RPh, PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine, and Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, Maryland.
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  • Ram Miller MDCM, MS

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine, and Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, Maryland.
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Address correspondence to Ann L. Gruber-Baldini, PhD, Associate Professor, Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 W. Redwood Street, Suite 200, Baltimore, MD 21201. E-mail: abaldin@epi.umaryland.edu

Abstract

OBJECTIVES: To establish nationally representative estimates of the use of agents to treat Alzheimer's disease and related dementias (ADRDs) and related behavioral symptoms in Medicare beneficiaries and to describe medication use according to residential status and other patient characteristics.

DESIGN: Cross-sectional prevalence study.

SETTING: Community and various long-term care (LTC) settings.

PARTICIPANTS: Twelve thousand six hundred ninety-seven beneficiaries from the 2002 Medicare Current Beneficiary Survey (MCBS), of whom 11,593 were community dwelling and 1,104 resided in various LTC settings.

MEASUREMENTS: ADRDs were identified according to International Classification of Diseases, Ninth Revision, codes in Medicare claims and self- and proxy reports. Medication use was derived from self-reports (community) and extracts of facility medication administration records (LTC).

RESULTS: In 2002, an estimated 3.4 million Medicare beneficiaries were diagnosed with ADRDs (8.1%), of whom 58.9% resided in the community (prevalence rate=5.1%) and 41.1% resided in LTC facilities (prevalence rate=57.2%). Use of antidementia drugs was similar across settings, with 24.7% of subjects with dementia in the community and 26.3% of those in LTC receiving prescriptions for donepezil, galantamine, or rivastigmine. Use of haloperidol was comparable (and low) in both settings. Use of atypical antipsychotics, especially risperidone, olanzapine, and quetiapine, was much higher in LTC residents (21.0%, 11.9%, and 7.1%, respectively) than in the community (5.1%, 4.0%, and 2.3%).

CONCLUSION: The prevalence of ADRDs in LTC settings is much larger than in the community, but there is little difference in the proportions receiving antidementia drugs, although LTC residents are more likely to be treated with atypical antipsychotics (risperidone, olanzapine, and quetiapine), presumably for behavioral symptoms.

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