Patterns of Dementia Treatment Use in Assisted Living Facilities: A Cross-Sectional Study of 1975 Demented Residents

Objectives: To report the associated factors with the nonuse of cholinesterase-inhibitors and memantine in residents from assisted living (AL) facilities suffering from dementia. Design: A cross-sectional study. Setting: The "Reseau de Recherche en Etablissement d'Hebergement pour Personnes Agees" (REHPA) network composed of 236 AL facilities in France. Participants: 4896 residents randomly selected by birth date. Measurements: A structured questionnaire was completed for each resident by the geriatricians of each AL facility. Demographics, medical history (including diagnosis of dementia), drugs (including specific dementia treatments), functional status and behavioral disturbances were collected. Multivariate linear regression analyses were performed. Results: Among the 1975 suffering from dementia, 49.1% were not specifically treated. The independent associated factors to the nonuse of dementia treatment were an institutional length of stay longer than 3 years (OR = 1.62; 95% Cl: 1.31-2.02), a transfer from a hospital (OR = 1.68; 95% Cl: 1.33-2.11) or another institution (OR = 2.06; 95% Cl: 1.45-2.93) before admission, being diagnosed by a specialist other than neurologist (GP: OR = 3.90; 95% Cl: 2.58-5.89) (psychiatrist: OR = 1.88; 95% Cl: 1.26-2.81) (geriatrician: OR = 1.42; 95% CI:1.08-1.87), a concomitant antipsychotic treatment (OR = 1.44; 95% Cl: 1.13-1.82), the absence of behavioral disturbances (OR = 1.51; 95% CI: 1.14-2.01), and a higher degree of disability (OR = 2.16; 95% Cl: 1.59-2.92). Conclusion: Nearly half of the dementia-affected residents were not specifically treated. The independent associated factors that have been identified in the study might bring light on the particular issues of dementia treatments in AL facilities. (J Am Med Dir Assoc 2011; 12: 648-654)