Tacrine therapy is associated with reduced mortality in nursing home residents with dementia

OBJECTIVES: To investigate the extent to which treatment with tacrine is associated with a reduction in mortality in nursing home residents with dementia. DESIGN: We performed a retrospective cohort study using the Systematic Assessment and Geriatric drug use via Epidemiology database, which contains data collected with the Minimum Data Set on a cross-section of over 400,000 nursing home residents in five U.S. states. SETTING: Retrospective data analysis of residents in nursing homes. PARTICIPANTS: We identified 1,449 users of tacrine and 6,119 nonusers matched on facility, date of tacrine use, level of cognitive function, and dementia diagnosis. MEASUREMENTS: Comparisons of the two groups were made for sociodemographic variables, dementia severity, number of medications, and major comorbid illness (heart disease, cancer, diabetes mellitus, chronic obstructive pulmonary disease, malnutrition), and survival over the 3-year study period. RESULTS: Based on Cox proportional hazards models, tacrine users showed a significantly lower mortality rate than nonusers. The hazard rate ratio was 0.76 (95% CI = 0.70-0.83). After adjusting for the confounding variables of sociodemographic factors, level of function in activities of daily living, cognitive function, number of drugs, and comorbid illnesses, this survival advantage was still significant at 0.85 (95% CI = 0.77-0.93). CONCLUSION: Treatment of nursing home residents with tacrine is associated with lower mortality. This observation has implications for the socioeconomic impact of cholinesterase inhibitor therapy in those with advanced dementia and for quality of life issues in the nursing home that deserve future investigation.

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