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J Am Geriatr Soc. 2017 Jan;65(1):77-82. doi: 10.1111/jgs.14429. Epub 2016 Sep 19.

Changes in Medication Use After Dementia Diagnosis in an Observational Cohort of Individuals with Diabetes Mellitus.

Author information

1
Center for Vulnerable Populations, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.
2
Division of Geriatrics, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California.
3
School of Medicine, University of Chicago, Chicago, Illinois.
4
Division of Research, Kaiser Permanente, Oakland, California.

Abstract

OBJECTIVES:

To assess changes in medication use after a diagnosis of dementia in individuals with type 2 diabetes mellitus.

DESIGN:

Difference-in-differences analysis of changes in the number of dispensed chronic medications between individuals with and without newly diagnosed dementia.

SETTING:

Integrated healthcare delivery system, Kaiser Permanente Northern California.

PARTICIPANTS:

Individuals aged 50 and older without prevalent dementia with type 2 diabetes mellitus enrolled in a baseline survey. During 5 years of follow-up, 193 individuals with a new diagnosis of dementia were identified, and risk-set sampling was used to randomly select five reference subjects per case matched on 5-year age categories and sex (965 matched participants), resulting in an analytical sample of 1,158.

MEASUREMENTS:

The exposure was new diagnosis of dementia. The primary outcome was change in number of current chronic medications (total, cardiovascular (blood pressure and lipid control), diabetes mellitus) at three times: 1 year before index date (preindex date), date of diagnosis of dementia or matched reference date (index date), and up to 1 year after index date or end of follow-up if censored before 1 year (postindex date).

RESULTS:

After adjustment, the number of chronic medications and the subset of cardiovascular medications declined after a dementia diagnosis in the overall cohort and in age-, sex-, and time-matched reference individuals, but the decline was significantly greater in the group with dementia (0.71 medications fewer than the reference group, P = .02). The number of diabetes mellitus medications declined in both groups, but the declines were not statistically different (0.18 medications fewer than the reference group, P = .008).

CONCLUSIONS:

Use of cardiometabolic medications fell after a diagnosis of dementia, as recommended in national guidelines.

KEYWORDS:

dementia; diabetes mellitus; polypharmacy

PMID:
27642180
PMCID:
PMC5366252
DOI:
10.1111/jgs.14429
[Indexed for MEDLINE]
Free PMC Article

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