The effect of cholinesterase inhibitors on risk of nursing home placement among medicaid beneficiaries with dementia

Abstract

The purpose of this study was to explore the effect of therapy with cholinesterase inhibitors (ChE-Is) on the risk of nursing home (NH) placement in patients with dementia. Participants were enrolled in the Florida Medicaid program during the fiscal year 1998 to 1999 (N=1188). Of these, 378 had Alzheimer disease as their only dementia diagnosis. About 50% of the sample received ChE-Is. The total follow-up period was 36 months. We used Cox proportional hazard regressions to estimate the risk of NH placement. After adjusting for age, sex, race, and cooccurring diagnoses, we found that dementia patients receiving ChE-Is had reduced risk of NH placement by 28% at 12 months [hazard ratio (HR)=0.72, 95% confidence interval (CI) 0.55-0.94] and 21% at 18 months (HR=0.79, 95% CI 0.62-0.99). The reduction in risk was more pronounced in patients with Alzheimer disease only and was still significant at 24 months after baseline (HR=0.66, 95% CI 0.43-0.99). At 36 months, the association between taking ChE-Is and risk of NH placement was not significant and the proportion of participants placed in a nursing was almost identical. Therapy with ChE-Is may temporarily reduce the risk of NH placement in Medicaid beneficiaries with dementia, thereby improving quality of life and preserving personal and societal resources.