Reducing CNS-active Medications to Prevent Falls and Injuries in Older Adults

项目总结 在65岁及以上的成年人中，跌倒是致命和非致命伤害的主要原因。那些药物 影响中枢神经系统(即中枢神经系统活性药物)是跌倒的一个关键的可改变的危险因素，以及 国家指南对那些有跌倒风险的人避免服用药物提供了明确的指导。然而， 医疗保健提供者和患者对与跌倒有关的药物的认识很低，到目前为止， 药剂师在促进用药审查和减少预防跌倒方面的作用一直有限。新的 因此，迫切需要采取各种办法来增加对建议的接受。一种多方面的方法是 对于成功减少和停用某些中枢神经系统活性药物通常是必不可少的，例如 苯二氮卓类和阿片类药物。止跌的目标是实施和评估基于团队的 药剂师、初级保健提供者和患者参与的干预措施，以减少对中枢神经系统活性物质的暴露 增加老年人跌倒和意外伤害风险的药物。我们干预的核心是 直接针对患者的教育和持续的提供者教育和支持。目标是：1)适应和 采用和实施循证药物所需的试验方法 用于综合保健系统的减少战略；2)实施和评估 使用观察性队列设计进行干预；以及3)评估干预的障碍和促进者 采用、实施和维护：临床领导影响、干预适应性和 实施成本。我们的干预队列将包括服用一个或多个中枢神经系统的老年人- 在卫生系统开始实施干预措施后使用活性药物。我们会比较一下这个 具有最近历史比较队列的组，该队列来自相同的健康计划，使用相同的资格标准 对于他们，我们有关于人口统计学、医疗和用药历史以及结果的可比数据。这个 主要结果是在24个月时接受药物治疗的跌倒。次要结果将是 意外服药过量，机动车撞车造成的伤害，以及 干预。我们的应用意义重大，因为削减不必要的中枢神经系统的务实方法- 积极用药，通过停止当前使用和防止未来使用，将极大地提高 卫生系统实施基于人群的跌倒和伤害预防的能力。随着年龄的迅速增长 人口和意外伤害的破坏性影响及其相关成本，这样的办法 是非常需要的。这样的模式还可以提高老年人更普遍的处方质量 成年人。

PROJECT SUMMARY Falls are the leading cause of fatal and non-fatal injuries among adults aged 65 and older. Medications that affect the central nervous system (i.e., CNS-active medications) are a key modifiable risk factor for falls, and national guidelines offer clear guidance on medications to avoid for those at risk of falls. However, healthcare provider and patient awareness of medications linked to falls is low, and to date the role of pharmacists in facilitating medication review and reduction to prevent falls has been limited. New approaches to increase uptake of recommendations are thus greatly needed. A multifaceted approach is often essential to successfully taper and discontinue certain CNS-active medications, such as benzodiazepines and opioids. The objective of STOP-FALLS is to implement and evaluate a team-based intervention involving pharmacists, primary care providers, and patients to reduce exposure to CNS-active medications that increase the risk of older adult falls and unintentional injuries. Central to our intervention is direct-to patient education and ongoing provider education and support. The aims are to: 1) ADAPT AND PILOT-TEST approaches necessary for adoption and implementation of evidence-based medication reduction strategies for use in an integrated health care system; 2) IMPLEMENT AND EVALUATE the intervention using an observational cohort design; and 3) ASSESS barriers and facilitators to intervention adoption, implementation and maintenance: clinical leadership influences, intervention adaptability, and implementation costs. Our intervention cohort will consist of older adults who are taking one or more CNS- active medications after the start of intervention implementation by the health system. We will compare this group with a recent historical comparison cohort from the same health plan using the same eligibility criteria for whom we have comparable data on demographics, medical and medication history, and outcomes. The primary outcome will be medically treated falls at 24 months. Secondary outcomes will be unintentional overdose, injuries due to motor vehicle crashes, and direct medical costs of the intervention. Our application is significant because pragmatic approaches to curtail unnecessary CNS- active medication use, by discontinuation of current use and preventing future use, will greatly enhance the capability of health systems to implement population-based fall and injury prevention. With a rapidly aging population and the devastating effects of unintentional injuries and their associated costs, such approaches are greatly needed. Such models could also improve the quality of prescribing more generally in older adults.