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

减少中枢神经系统活性药物以预防老年人跌倒和受伤

• 批准号: 10335732
• 负责人: SHELLY L GRAY
• 金额: $ 70.76万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2022-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10335732
• 关键词: Reducing; CNS; active; Medications; Prevent

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.

项目概要 跌倒是 65 岁及以上成年人致命和非致命伤害的主要原因。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危险因素，并且 国家指南为有跌倒风险的人避免使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相关的药物的认识较低，迄今为止， 药剂师在促进药物审查和减少预防跌倒方面受到限制。新的 因此，迫切需要采取措施来提高建议的采纳率。多方面的方法是 通常对于成功减少和停止某些中枢神经系统活性药物至关重要，例如 苯二氮卓类药物和阿片类药物。 STOP-FALLS 的目标是实施和评估基于团队的 涉及药剂师、初级保健提供者和患者的干预措施，以减少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以及持续的提供者教育和支持。目标是： 1) 适应并 采用和实施循证药物所需的试点测试方法 用于综合卫生保健系统的减少战略； 2) 实施和评估 使用观察队列设计进行干预； 3) 评估干预的障碍和促进因素 采用、实施和维护：临床领导影响、干预适应性和 实施成本。我们的干预队列将由正在服用一种或多种中枢神经系统的老年人组成 卫生系统开始实施干预措施后积极用药。我们将比较这个 使用相同资格标准与来自同一健康计划的最近历史比较队列进行分组 对于他们，我们拥有有关人口统计、医疗和药物史以及结果的可比数据。这 主要结局是在 24 个月时接受药物治疗。次要结果将是 意外用药过量、机动车碰撞造成的伤害以及直接医疗费用 干涉。我们的应用非常重要，因为可以采取务实的方法来减少不必要的 CNS- 积极使用药物，通过停止当前使用并预防未来使用，将大大提高 卫生系统实施基于人群的跌倒和伤害预防的能力。随着快速衰老 人口和意外伤害的破坏性影响及其相关成本，此类方法 非常需要。此类模型还可以提高老年人的处方质量。 成年人。