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• W2017474671 abstract "LONG BEACH, CALIF. — Thirty-eight of 40 older adults who had dementia but were able to hold their breath for 10 seconds also were able to use an inhaler successfully with assistance. People with dementia commonly have chronic lung disease, and metered-dose inhalers or dry-powder inhalers are main-stays of treatment. The prospective study assessed adults in nursing homes with an average age of 86 years and Mini-Mental Status Examination (MMSE) scores from 10 to 24 who had never used a multiunit dry powder inhaler that goes by the trade name Diskus. The 21 subjects with MMSE scores of 17.7 or higher succeeded in using the inhaler after two tries when supervised and assisted by people who had been trained in using the device, Meenakshi Patel, MD, CMD, and her associates reported. Of the remaining subjects, 17 succeeded on the third try and 2 were unable to use the inhaler successfully, she and her associates reported in a poster presentation at the AMDA annual symposium. Among those who succeeded on the third try, MMSE scores were as low as 10, noted Dr. Patel, director of geriatrics at Wright State University, Dayton, Ohio. The mean MMSE score for the study subjects as a whole was 17.4. The investigators created a scale of 0–19 to assess subjects' ability to complete the seven steps involved in the use of the inhaler, including opening the cover, snapping the mouthpiece into position, sliding a lever until it clicks, keeping the inhaler horizontal, spontaneously putting the inhaler to their lips, breathing in deeply and quickly, holding the breath for 10 seconds, and closing the device. Subjects who succeeded in using the inhaler within three tries had a rating scale score as low as 7.6. Every one-point increase on the MMSE was associated with a 0.345-point increase in the device rating scale score after controlling for possible effects of age, sex, and education, a regression analysis revealed. The prospective study's findings appear to be more optimistic about inhaler use than results of three previous studies, which suggested that cognitive impairment hinders proper use of inhalers. A 2003 randomized study of 30 frail elderly patients found that few with abnormal MMSE scores were able to use inhalers independently despite training (Age Ageing 2003;32:299–302). A more recent study of 80 older adults suggested that those with an MMSE score less than 24 were unlikely to be able to use a metered-dose inhaler (Int. J. Clin. Pract. 2009;63:1150–3). A study of 51 older adults, from 1996, also found that an MMSE score lower than 24 was associated with being unable to correctly use a metered-dose inhaler (Arch. Intern. Med. 1996;156:984–8). If further studies could be conducted in assisted-living facilities, which provide less nursing oversight, they might help determine the minimum amount of supervision or assistance needed for residents with varying degrees of cognitive impairment to effectively use inhalers, the investigators suggested. GlaxoSmithKline, which markets the Diskus inhaler, funded the study. Sherry Boschert is with the San Francisco bureau of Elsevier Global Medical News." @default.
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• W2017474671 title "Patients With Dementia Can Use Inhalers" @default.
• W2017474671 doi "https://doi.org/10.1016/s1526-4114(10)60162-x" @default.
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