Pharmacological Management of Pain In Alzheimer's Disease and Related Dementia

摘要：我的职业目标是成为一名独立的老年药物流行病学家，在 疼痛和老龄化领域的药物治疗质量测量和结果评估。临床部 我的研究重点集中在老年人多种疾病的管理上，特别是 精神和身体疾病的相互作用及其治疗。健康问题组合的一个例子是 患有阿尔茨海默病和相关痴呆(ADRD)并患有慢性痴呆的老年患者 疼痛。到目前为止，止痛药处方的质量和患者疼痛控制不良的后遗症的数据 与ADRD的合作非常稀少。调查这些关联的研究受到样本量小的限制，而且没有一项研究是这样 试图确定适当的疼痛控制在预防心理健康(MH)障碍方面的效果。这个 我的K01建议研究的目标是提供初步数据，以提高我们对当前 止痛药处方和实践与止痛指南之间的潜在差异，以及 为未来关于疼痛控制在减少ADRD中MH问题中的作用的研究制定假设。 我们提出了一个纵向设计，使用4年(2011-2014)的Medicare 5%样本，其账单记录为 链接到养老院住院医生评估数据(最小数据集，MDS，3.0)。因为目前还不清楚 MDS 3.0能否准确检测出患有疼痛和MH障碍的患者，我们首先进行可行性研究 在两个护士的医疗记录中验证基于MDS的疼痛、抑郁和行为症状 家园(目标1)。利用具有全国代表性的Medicare-MDS数据，我们探索了 ADRD和非ADRD非ADRD患者的药理性疼痛管理及其决定因素 癌痛(目标2)。质量将基于五个常见的临床标准进行检查-止痛药 药物不良事件的选择、止痛药计划、药物预防、禁忌证 药物使用，以及全面的疼痛控制。然后我们探索疼痛控制在多大程度上与 降低部分MH疾病的风险，包括抑郁、行为症状、焦虑和睡眠 ADRD的障碍(目标3)。这个项目是为我量身定做的，以应用知识和技能，将 从我的主要导师Almut Winterstein博士的培训活动中获得(药物流行病学，质量 测量和结果评估)和共同导师：Roger Fillingim博士(疼痛)，Marco Pahor(衰老)， Babette Brumback(纵向数据的高级方法)和Laurence Solberg(临床老年护理和 评估)。为了获得进一步的指导，我征求了西格弗里德·施密特博士在止痛药领域的专业意见。 以及ADRD的史蒂文·德科斯基博士。这个K01奖将为我提供受保护的时间来接受培训 需要准备R01拨款申请，以检查止痛药实践及其对健康的影响 ADRD的结果。这一系列研究的结果有望带来更好的药理疼痛。 管理和改善有认知障碍的老年人的疼痛和健康结果。

Summary: My career goal is to become an independent geriatric pharmacoepidemiologist with expertise in pharmacotherapy quality measurement and outcomes evaluation in the fields of pain and aging. The clinical focus of my research has centered on the management of multi-morbidity in older adults and particularly, the interplay of mental and physical disease and its treatment. One example of combination of health problems is elderly patients who live with Alzheimer's disease and related dementia (ADRD) and also suffer from chronic pain. To date, data on quality of pain medication prescribing and the sequelae of poor pain control in patients with ADRD are scarce. Studies investigating these associations are limited by small sample size, and none has attempted to establish the effect of adequate pain control on preventing mental health (MH) disorders. The goal of my K01 proposed research is to provide preliminary data that improve our understanding of current pain medication prescribing and potential discrepancies between practices and pain guidelines, and to formulate hypotheses for future research regarding the role of pain control in reducing MH problems in ADRD. We propose a longitudinal design using 4 years (2011-2014) of Medicare 5% sample whose billing records are linked to nursing home resident assessment data (Minimum Data Set, MDS, 3.0). Because it is unclear whether MDS 3.0 can accurately detect patients with pain and MH disorders, we first conduct a feasibility study of validating MDS-based pain, depression, and behavioral symptoms against medical records at two nursing homes (Aim 1). With the nationally representative Medicare-MDS data, we explore the quality of pharmacological pain management and its determinants among ADRD and non-ADRD residents with non- cancer pain (Aim 2). The quality will be examined based on five common clinical standards--pain medication selection, pain medication scheduling, pharmacological prevention of drug adverse event, contraindicated medication use, and overall pain control. We then explore the extent to which pain control is associated with a decreased risk for select MH disorders, including depression, behavioral symptoms, anxiety, and sleep disorders in ADRD (Aim 3). This project is well tailored for me to apply the knowledge and skills that will be obtained from training activities with my Primary Mentor, Dr. Almut Winterstein (pharmacoepidemioloy, quality measurement and outcome assessment) and Co-Mentors: Drs. Roger Fillingim (pain), Marco Pahor (aging), Babette Brumback (advanced methods for longitudinal data), and Laurence Solberg (clinical geriatric care and assessment). For further guidance, I enlist the expertise of Dr. Siegfried Schmidt in the field of pain medicine and Dr. Steven DeKosky in ADRD. This K01 award will provide protected time for me to receive training needed to prepare an R01 grant application to examine pain medication practices and their impact on health outcomes in ADRD. The results from this line of research are expected to lead to better pharmacological pain management and improved pain and health outcomes in older adults with cognitive impairments.