Anti-dementia drugs may help delay people’s admission to care homes: findings from observational study

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Prescribing anti-dementia drugs to patients could help delay their admission to care homes, according to a new study published in the October issue of The Psychiatrist.

Psychiatrists Dr Emad Salib and Dr Jessica Thompson studied a total of 339 people with dementia, who were referred to psychiatric services in Peasley Cross Hospital in St Helens in 2006.

127 of the patients (24%) had been prescribed cholinesterase inhibitors. These drugs can help slow the progression of the disease by preventing an enzyme known as acetylcholinesterase from breaking down acetylcholine in the brain. Of the patients who were prescribed cholinesterase inhibitors, almost three-quarters (74%) were given donepezil (which is marketed under the trade name Aricept). A further 14% were given galantamine (trade name Reminyl), 8% rivastigmine (trade name Exelon), and 4% memantine (trade name Ebixa).

The remaining 212 patients in the study were not prescribed cholinesterase inhibitors. After four years, the researchers followed up all 339 patients to see if they had been placed in care or remained in their own home.

The researchers found that, on average, patients who did not take anti-dementia drugs moved to care homes sooner than patients who did. There was a delay in admission to care homes by a median of 12 months for patients who took anti-dementia drugs, compared to those who did not.

However, after three years, an equal proportion of patients from both treatment groups had been admitted to care homes. In other words, the delay in admission was relatively short-lived.

Dr Emad Salib, a consultant psychiatrist and lead author of the research, said:

Our study provides some evidence to suggest that prescribing cholinesterase inhibitors is associated with a delay in care home placement in the first 2.5 years of treatment. However, we cannot say whether this association is causal or if it is the result of a number of different factors.

Moving a person to a care home is a significant and distressing event both for the individual and their family, and most carers wish to maintain home care for as long as possible. Any measure that may help to delay institutional care is invaluable, but we must ensure the evidence is robust. That’s why we welcome the recommendation by the National Institute for Health and Clinical Excellence (NICE) for further research in this area.

Salib E and Thompson J. Use of anti-dementia drugs and delayed care home placement: an observational study (PDF). The Psychiatrist 2011; 35: 384-388.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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