Variation in the management of herpes zoster among US nursing home residents with and without dementia

TL;DR

This study found that nursing home residents with dementia may be undertreated for shingles compared to those without dementia.

Contribution

The study reveals medication use disparities in managing shingles between dementia and non-dementia nursing home residents.

Findings

Residents without dementia had higher increases in oxycodone and gabapentin use after shingles diagnosis.

Prednisone use was 1.74 times higher in residents without dementia compared to those with dementia.

Acyclovir use was similar between residents with and without dementia.

Abstract

Herpes zoster (HZ) is a painful condition that is managed with a combination of antivirals, steroids, and pain medications. Nursing home residents with Alzheimer’s disease and related dementias (ADRD) may have difficulty expressing HZ symptoms, thus affecting medication management. This study compared prescription and non-prescription medication use in nursing home residents with HZ by ADRD diagnosis. We conducted a retrospective cohort study using nursing home electronic health record data from 2017-2022. Residents with HZ and ADRD were identified using ICD-10 codes as of the HZ diagnosis date. Administration for pain medications, antivirals, and steroids were measured before and after the HZ diagnosis date in periods of time (e.g., 1-7, 8-14, and 15-30 days before/after diagnosis). To assess relative changes in medication prevalence over time, administrations 15-30 days prior to HZ represented the baseline period. We identified 4,719 residents with HZ (31.5% had ADRD). Among residents without ADRD, oxycodone increased from 1.6% to 3.4% (vs. ADRD=0.5% to 0.8%) and gabapentin from 13.4% to 33.9% (vs. ADRD=12.6% to 25.6%) between baseline and 0-7 days after HZ diagnosis. In the 0-7 days after HZ diagnosis, prednisone use was 1.74 times greater in residents without ADRD (10.3%) vs. with ADRD (5.9%), and acyclovir use was similar between groups (without ADRD=28.5%; with ADRD=27.1%). Differences in medications, especially prednisone, between residents with and without ADRD may reflect undertreatment of HZ symptoms in residents with ADRD.