Tacrine use in nursing homes - Implications for prescribing new cholinesterase inhibitors

Objective: To describe the use of tacrine in nursing home residents using d ata from a clinically based resident assessment instrument used by all US n ursing homes. Methods: Data were from the Systematic Assessment of Geriatri c Drug Use via Epidemiology (SAGE) database, a population-based data set wi th information on 329,520 patients admitted to all Medicare/Medicaid certif ied nursing homes in four US states (Maine, Mississippi, New York, and Sout h Dakota) from 1992 through 1995. The SAGE database combines information fr om the Minimum Data Set (MDS) and the On-Line Survey and Certification Auto mated Record. We identified all residents receiving tacrine and up to five control residents per case matched on state, date of tacrine use, cognitive function, and dementia diagnosis. Results: A total of 1,640 (0.5%) nursing home residents received tacrine at least once. Only 38% of these residents had a diagnosis of AD documented on the MDS; regardless of dementia diagno sis, 25% had severe cognitive impairment, 35% were severely dependent in ac tivities of daily living (ADL), and 17% had both severe cognitive and ADL i mpairment. Only 8% achieved a therapeutic dose of at least 120 mg/d. After adjusting for confounding variables, wandering and being physically abusive were the strongest predictors of tacrine use. Conclusions: A minority of n ursing home residents received tacrine. Of those who did, a significant pro portion were unlikely to benefit from its use because of their level of cog nitive and ADL impairment, or because low doses were used. As new medicatio ns become available for dementia, MDS data can be used by nursing homes to monitor the use of these therapies.