Background
Methods
Design and study population
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age of at least 65 years,
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at least one ICD-10 code for dementia from the following list (F00.x, F01.x, F02.0, F02.3, F03, G30.x, G31.0, G31.1, G31.82, G31.9, and R54) in outpatient care in at least 3 of 4 consecutive quarters,
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continuous insurance period in the year before and after the first code was recorded.
Cholinesterase inhibitors and covariates
Symptom complexes characterizing geriatric patients | ICD-10 codes |
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Immobility | M96.8, M62.3, M62.5 |
Falls risk and dizziness | R26, R29.81, R42, H81, H82 |
Incontinence | R32, N39.3, N39.4, R15 |
Pressure ulcer | L89, L97, I83.0, I83.2, L98.4 |
Malnutrition | R64, E41, E43, E44 |
Disorders of fluid and electrolyte balance | E86, E87, R60 |
Depression and anxiety | F32, F33, F30, F31, F40, F41 |
Pain | R52, R51, N23, R10, M54, K08.88, F62.80, H57.1, M79.6, M25.5, R07.0-R07.4, N64.4, H92.0, F45.4, M75.8, K14.6 |
Neuropathies | R20, G50-G59, G60-G64 |
Frailty | R54 |
Severe visual disturbances and hearing loss | H53, H54, H52.4, H25, H28, H90, H91 |
Medication problems | Y57.9, X49.9 |
High risk of complications | Z98, Z48, Z43, T79-T89, Z99.2, I48 |
Delayed convalescence | Z54 |
Statistical analysis
Results
Characteristics of the study cohort
Baseline characteristics | |
---|---|
Mean age, in years (SD) | 78.7 (7.4) |
Age groups, in years | |
65-74 | 30.6% |
75-84 | 47.1% |
85+ | 22.3% |
Sex | |
Male | 52.4% |
Female | 47.6% |
Area of residence* | |
Urban | 72.0% |
Rural | 28.0% |
Number of prescribed medications | |
Mean (SD) | 9.7 (5.7) |
Minimum (Q0, 0th percentile) | 0 |
First quartile (Q1, 25th percentile) | 6 |
Second quartile (Q2, median, 50th percentile) | 9 |
Third quartile (Q3, 75th percentile) | 13 |
Maximum (Q4, 100th percentile) | 51 |
Level of care dependency | |
None | 55.6% |
1 | 20.7% |
2 | 18.5% |
3 | 5.2% |
Symptom complexes characterizing geriatric patients | |
Severe visual disturbances and hearing loss | 47.7% |
Pain | 46.1% |
High risk of complications | 35.9% |
Depression and anxiety | 32.9% |
Incontinence | 24.0% |
Falls risk and dizziness | 21.9% |
Neuropathies | 17.4% |
Disorders of fluid and electrolyte balance | 15.4% |
Pressure ulcer | 9.5% |
Frailty | 3.9% |
Others (immobility, malnutrition, medication problems, delayed convalescence) | 2.7% |
Number of symptom complexes characterizing geriatric patients | |
0 | 8.0% |
1-2 | 44.8% |
3-4 | 34.5% |
5+ | 12.7% |
Contacts to neurologists/psychiatrists | |
0 | 55.4% |
1-2 | 9.0% |
3-5 | 9.8% |
6-9 | 12.2% |
10+ | 13.6% |
Prescribing of cholinesterase inhibitors
Factors associated with prescribing
Characteristics | ChEI users (n = 241) | Non-users (n = 1,607) | Proportion of ChEI user (n = 1,848) | Model 1a)
ORcrude (95% CI) | Model 2b)
ORadj (95% CI) |
---|---|---|---|---|---|
Age groups, in years | |||||
65-74 | 107 (44.4%) | 459 (28.6%) | 18.9% | 3.32 (2.13-5.18) | 1.41 (0.85-2.34) |
75-84 | 107 (44.4%) | 763 (47.5%) | 12.3% | 2.00 (1.29-3.10) | 1.30 (0.81-2.11) |
85+ | 27 (11.2%) | 385 (24.0%) | 6.6% | 1 | 1 |
Sex | |||||
Male | 137 (56.8%) | 832 (51.8%) | 14.1% | 1.23 (0.93-1.61) | 0.89 (0.65-1.21) |
Female | 104 (43.2%) | 775 (48.2%) | 11.8% | 1 | 1 |
Area of residence* | |||||
Urban | 168 (69.7%) | 1161 (72.3%) | 12.6% | 1 | 1 |
Rural | 73 (30.3%) | 444 (27.7%) | 14.1% | 1.14 (0.85-1.53) | 1.48 (1.06-2.06) |
Number of prescribed medications | |||||
Q1 (0-6) | 90 (37.3%) | 520 (32.4%) | 14.8% | 1.43 (0.97-2.10) | 0.93 (0.58-1.49) |
Q2 (7-9) | 59 (24.5%) | 352 (21.9%) | 14.4% | 1.38 (0.91-2.10) | 1.03 (0.64-1.65) |
Q3 (10-13) | 48 (19.9%) | 372 (23.1%) | 11.4% | 1.06 (0.69-1.64) | 0.79 (0.49-1.28) |
Q4 (14+) | 44 (18.3%) | 363 (22.6%) | 10.8% | 1 | 1 |
Level of care dependency | |||||
None | 161 (66.8%) | 866 (53.9%) | 15.7% | 5.83 (1.82-18.61) | 5.35 (1.61-17.81) |
1 | 41 (17.0%) | 341 (21.2%) | 10.7% | 3.77 (1.14-12.44) | 4.32 (1.26-14.75) |
2 | 36 (14.9%) | 306 (19.0%) | 10.5% | 3.69 (1.11-12.24) | 3.97 (1.16-13.60) |
3 | 3 (1.2%) | 94 (5.8%) | 3.1% | 1 | 1 |
Symptom complexes characterizing geriatric patients | |||||
0 | 33 (13.7%) | 115 (7.2%) | 22.3% | 3.46 (1.87-6.41) | 4.23 (2.06-8.69) |
1-2 | 120 (49.8%) | 707 (44.0%) | 14.5% | 2.05 (1.22-3.44) | 2.52 (1.41-4.50) |
3-4 | 70 (29.0%) | 568 (35.3%) | 11.0% | 1.49 (0.87-2.55) | 1.59 (0.89-2.84) |
5+ | 18 (7.5%) | 217 (13.5%) | 7.7% | 1 | 1 |
Contacts to neurologists/psychiatrists | |||||
0 | 43 (17.8%) | 981 (61.0%) | 4.2% | 1 | 1 |
1-2 | 16 (6.6%) | 151 (9.4%) | 9.6% | 2.42 (1.33-4.40) | 2.53 (1.37-4.65) |
3-5 | 44 (18.3%) | 137 (8.5%) | 24.3% | 7.33 (4.64-11.57) | 7.86 (4.88-12.66) |
6-9 | 84 (34.9%) | 141 (8.8%) | 37.3% | 13.59 (9.04-20.43) | 14.05 (9.14-21.59) |
10+ | 54 (22.4%) | 197 (12.3%) | 21.5% | 6.25 (4.07-9.60) | 7.66 (4.85-12.11) |