The use of a cholinesterase inhibitor review committee in long-term care

Objective: The objective of the study was to document the effectiveness of a Cholinesterase Inhibitor (ChE-I) Review Committee in a long-term care (LTC) institution in Montreal, Canada. Design: Retrospective cohort study. Setting: Maimonides Geriatric Centre (MGC), a 387-bed LTC facility in Montreal, Canada, in which 352 patients have dementia. Participants: Fifty-two patients on ChE-I who were reviewed at least once by the ChE-I Review Committee between January and November 2005. Measurements: Recommendations for discontinuation, actual discontinuation, and restarting of ChE-I, along with reasons underlying these decisions, were collected from the patients' charts over a 4-month period following Review Committee assessment. Results: The Review Committee recommended discontinuation of ChE-I in 17 (32.7%) of the 52 patients. After 1 patient died and therefore was excluded from the study, 13 (81.3%) of the remaining 16 were actually discontinued. The most common reasons for recommendation to discontinue ChE-I were insufficient benefit on cognition, activities of daily living (ADL), and behavior. Subsequently, ChE-I was resumed in 4 (30.8%) of the 13 patients discontinued, 2 because of ADL deterioration and 2 at the request of the family. Conclusions: Through the review process, almost one third of ChE-I users were recommended for discontinuation because of insufficient benefit; the majority of these were discontinued. Fewer than one third were subsequently restarted. A ChE-I Review Committee seemed to be an effective and acceptable model for decision making regarding ChE-I use in LTC.