Health Impacts of Prehospital Pain Management for Injured Older Adults

院前疼痛管理对受伤老年人的健康影响

• 批准号: 10379366
• 负责人: Molly Price Jarman
• 金额: $ 13.1万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10379366
• 关键词: 911 call; Absence of pain sensation; Accounting; Acute; Acute Pain; Acute pain management; Address; Advanced Development; Age; Aging; American; Anatomy; Award; Brain; Caring; Cause of Death; Cessation of life; Characteristics; Country; Data Linkages; Delirium; Dementia; Destinations; Diagnosis; Effectiveness; Elderly; Emergency Department Physician; Emergency medical service; Expenditure; Face; Female; Fracture; Freedom; Funding; Geographic Locations; Geography; Guidelines; Health; Health Service Area; Health Status; Health system; Home; Hospitals; Hour; Human Resources; Impaired cognition; Incidence; Infrastructure; Injury; Injury Severity Score; Intensive Care Units; Intervention; Investments; Knowledge; Length of Stay; Life; Limb structure; Literature; Medical emergency; Medicare; Medicare claim; Mentored Research Scientist Development Award; Mentorship; Methodology; Methods; Modeling; Mollies; Multiple Trauma; Narcotics; National Institute on Aging; Older Population; Operative Surgical Procedures; Opiate Addiction; Opioid; Opioid Analgesics; Outcome; Pain; Pain management; Pathway interactions; Patient Care; Patients; Patterns of Care; Pharmaceutical Preparations; Physiological; Population; Practice Guidelines; Pre-hospitalization care; Probability; Process; Protocols documentation; Provider; Public Health; Records; Recovery; Recovery of Function; Research; Research Personnel; Resources; Risk; Self-Injurious Behavior; Severities; Statistical Methods; Structure; Time; Time Management; Training; Transportation; Trauma; Traumatic injury; United States; Variant; Vehicle crash; Wages; Woman; Work; advanced analytics; analytical method; assault; care systems; career; chronic pain; college; dementia risk; demographics; disability; economic evaluation; effective therapy; experience; falls; frailty; functional outcomes; functional status; hazard; improved; injured; injury recovery; inpatient service; instructor; mortality; opioid use; optimal treatments; pain relief; practical application; prevent; psychosocial; rural area; service organization; service providers; severe injury; skills; trauma care; trauma centers; treatment services; urban area

PROJECT SUMMARY Traumatic injury is a leading cause of death and disability for older adults in the United States. Due to the physiological and psychosocial processes of aging, older adults have unique trauma care needs. Unfortunately, current guidelines for trauma care and emergency medical services (EMS) to not adequately address these needs. The impact of prehospital care on health outcomes represents a substantial gap in the literature for the treatment of injured older adults. Approximately 10% of injured older adults receive opioid analgesia for pain management during the prehospital interval, or the time from the onset of injury until hospital arrival. Little is known about the consequences of these interventions. Prehospital opioid analgesia could decrease risk of delirium by managing severity of acute pain, and thereby reducing the accumulation of factors disrupting normal brain activity and improving health outcomes. Conversely, opioid pain medications are neuroactive drugs that can disrupt brain activity, increasing risk of delirium and worsening health outcomes. By either pathway, prehospital administration of opioid analgesia has profound implications for short- and long-term health and functional status of injured older adults. This application for a National Institute on Aging Mentored Research Scientist Development Award (K01) seeks support for Dr. Molly Jarman, a new Instructor of Surgery at the Brigham and Women’s Hospital Center for Surgery and Public Health who aspires to a career focused on improving the quality, effectiveness, and accessibility of prehospital EMS and trauma care systems for the older adult population in the United States. Dr. Jarman’s prior research has focused on geographic determinants of injury mortality and access to trauma center care. To extend the impact and practical application of this research, Dr. Jarman proposes to move her research toward geriatric trauma outcomes, addressing the emerging need for trauma care optimized for the aging United States population. Accordingly, the K01 training is focused on gaining knowledge in geriatric trauma care and prehospital trauma care services, as well as statistical methods for causal inference and economic analysis. The proposed research will employ advanced analytic methods to closely examine the impact of prehospital pain management interventions. Research aims will include (1) an assessment of factors influencing EMS use of prehospital opioid analgesia for injured older adults, (2) short- and long-term health outcomes associated with prehospital opioid analgesia, and (3) estimation of Medicare expenditures during the first year following injury for patients with and without prehospital pain management. The practical application of this work will be to inform efforts by national, state, and local EMS leaders seeking to provide appropriate care for injured older adults during the prehospital interval, including changes to practice guidelines and investment in EMS infrastructure and/or personnel training. By providing salary support, training, freedom from administrative responsibilities, and formal mentorship structure, this award will facilitate Dr. Jarman’s transition to an independent research career focused on improve health outcomes and functional status of injured older adults.

项目摘要 创伤性伤害是美国老年人死亡和残疾的主要原因。由于生理 老年人的衰老社会心理过程有独特的创伤护理需求。不幸的是，当前的指南 创伤护理和紧急医疗服务（EMS）无法充分满足这些需求。院前的影响 对健康结果的护理代表了治疗受伤老年人的文献中的一个巨大差距。 在院前间隔期间，约有10％的受伤的老年人接受阿片类镇痛治疗疼痛治疗， 或从受伤发作到医院到达的时间。这些干预措施的后果知之甚少。 院前阿片类镇痛可通过管理急性疼痛的严重程度来降低del妄的风险，从而减少 因素的积累破坏了正常的大脑活动并改善健康结果。相反，阿片类药物疼痛 药物是神经活性药物，可以破坏大脑活动，增加ir妄的风险和担心健康 结果。通过这两种途径，阿片类镇痛的院前给药对短期和 受伤老年人的长期健康和功能状况。该国家衰老研究所的申请 指导的研究科学家发展奖（K01）寻求对手术的新讲师Molly Jarman博士的支持 在杨百翰和妇女医院外科和公共卫生中心，他们渴望从事专注于职业 改善老年人院前EMS和创伤系统的质量，有效性和可及性 在美国的人口。 Jarman博士的先前研究重点是地理确定伤害死亡率 并获得创伤中心护理。为了扩展这项研究的影响和实际应用，Jarman博士的建议 为了将她的研究转向老年创伤结果，解决了优化的创伤护理需求 美国老化的人口。彼此之间，K01培训的重点是获得老年创伤的知识 护理和院前创伤护理服务以及因果推理和经济分析的统计方法。 拟议的研究将采用先进的分析方法来密切检查院前疼痛的影响 管理干预措施。研究目的将包括（1）对因素的评估影响EMS的使用院前的使用 受伤的老年人的静脉镇痛，（2）与院前卵虫类药物相关的短期和长期健康结果 镇痛和（3）受伤患者和患者受伤后的第一年，医疗保险支出 没有院前疼痛管理。这项工作的实际应用将是为国家，国家， 和当地的EMS领导人寻求在院前间隔期间为受伤的老年人提供适当的护理， 包括更改实践指南和对EMS基础设施和/或人员培训的投资。通过提供 薪水支持，培训，免于行政责任和正式心态结构，该奖项将 促进Jarman博士向独立研究职业的过渡，重点是改善健康成果和功能 受伤老年人的状况。