Donepezil use in US nursing homes

Donepezil is effective in slowing the progression of Alzheimer's disease (AD). No data are available on the patterns of donepezil use among nursing home residents. We estimate the prevalence of the use of donepezil and the frequency of its initiation, and describe the demographic and clinical characteristics of residents taking this drug.

We used data from the Minimum Data Set (N=174659). We compared users and non-users of donepezil with respect to demographic, clinical and functional variables. We estimated the 6-month incidence of donepezil use. All analyses were stratified by the admission status of the residents (newly admitted/long-stay).

Among those meeting the manufacturer's indication for donepezil (mild to moderate AD), the prevalence of use was 30% among newly admitted, and 19% among long-stay residents. About 3% of residents not meeting the manufacturer's indication for donepezil were taking it. The proportion of people with AD still taking donepezil after six months was 44.8% among newly admitted, and 59.5% among long-stay residents. Donepezil use was associated with cognitive impairment, behavioral problems and the use of psychotropic drugs including anti-psychotics and anti-depressants. In people without a diagnosis of AD, there seems to be an association between behavioral problems and use of donepezil.

Donepezil is frequently used in the nursing home setting for the management of AD. Off-label use of donepezil is also relatively frequent. This may reflect an empirical perception of effectiveness on outcomes different from cognitive impairment, such as behavioral problems, although evidence is lacking.