Deprescribing of acetyle cholinesterase inhibitors safe for patients with severe dementia

Deprescribing acetyl cholinesterase inhibitors (AChEIs) in elderly adults with severe dementia does not appear to result in the occurrence of negative events, a recent study has shown.

The study included 37,106 elderly nursing house residents (aged ≥65 years; 75.5 percent female) who had severe dementia and were on AChEI medication. Study outcomes included the effects of deprescription on all-cause negative events and on serious falls or fractures.

Almost a third of the participants (31.6 percent) experienced all-cause negative events, while 9.2 percent were hospitalized for falls or fractures. Events were documented over a median follow-up of 226 and 259 days, respectively. The corresponding event rates were 0.56 and 0.15 per person-year.

Visits to the emergency department occurred with the greatest frequency among all-cause negative events (16.1 percent), followed by hospitalizations (8.4 percent) and deaths (7.1 percent).

Patients who had AChEIs deprescribed suffered from a higher rate of all-cause negative events relative to their counterparts who maintained the medication (0.62 vs 0.55 events per person-year). However, the rate of falls or fractures was lower in the former (0.09 vs 0.16 events per person-year).

Unadjusted models confirmed this finding. Deprescribing AChEIs led to a significant increase in the likelihood of all-cause negative events (odds ratio [OR], 1.17, 95 percent confidence interval [CI], 1.11–1.23) and a lower overall risk of falls and fractures (OR, 0.59, 95 percent CI, 0.52–0.66).

However, adjusting for potential confounders attenuated the effect of deprescription on all-cause negative events (adjusted OR, 1.01, 95 percent CI, 0.95–1.07) while retaining its protective effect on falls and fractures (adjusted OR, 0.65, 95 percent CI, 0.56–0.73).

“Our findings suggest that deprescribing AChEIs is a reasonable approach to reduce the risk of serious falls or fractures without increasing the risk for all-cause [negative] events,” said researchers.