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 创伤性损伤是美国老年人死亡和残疾的主要原因。由于生理原因， 和老化的心理社会过程，老年人有独特的创伤护理需求。不幸的是，目前的准则， 创伤护理和紧急医疗服务（EMS）不能充分满足这些需求。院前影响 在治疗受伤老年人的文献中，对健康结果的护理是一个巨大的空白。 大约10%的受伤老年人在入院前接受阿片类镇痛药进行疼痛管理， 或从受伤开始到到达医院的时间。人们对这些干预措施的后果知之甚少。 院前阿片类镇痛可以通过控制急性疼痛的严重程度来降低谵妄的风险，从而减少 破坏正常大脑活动和改善健康结果的因素的积累。相反，阿片类药物疼痛 药物是神经活性药物，可以扰乱大脑活动，增加谵妄和健康恶化的风险 结果。通过这两种途径，院前给予阿片类药物镇痛对短期和长期的疼痛有深远的影响。 长期健康和功能状态的受伤老年人。这个国家老龄化研究所的申请 指导研究科学家发展奖（K 01）寻求支持莫莉贾曼博士，一个新的外科导师 在布里格姆妇女医院外科和公共卫生中心，她渴望从事以下职业： 提高老年人院前EMS和创伤护理系统的质量、有效性和可及性 美国的人口。贾曼博士先前的研究集中在伤害死亡率的地理决定因素上 以及创伤中心的护理为了扩大这项研究的影响和实际应用，贾曼博士建议 将她的研究转向老年创伤结局，解决创伤护理的新需求， 美国人口老龄化。因此，K 01培训的重点是获得老年创伤知识 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。的 拟议中的研究将采用先进的分析方法，仔细检查院前疼痛的影响， 管理干预。研究目的将包括（1）评估影响EMS使用的因素， 阿片类镇痛对受伤老年人，（2）短期和长期的健康结果与院前阿片类药物 镇痛，和（3）估计医疗费用在第一年内受伤的病人， 没有院前疼痛管理。这项工作的实际应用将为国家、州、 以及当地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， 包括对实践指南的修改以及对环管系统基础设施和/或人员培训的投资。通过提供 工资支持，培训，从行政责任的自由，和正式的导师结构，这个奖项将 促进贾曼博士过渡到一个独立的研究生涯，重点是改善健康结果和功能 受伤的老年人。