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.

项目概要 创伤性伤害是美国老年人死亡和残疾的主要原因。由于生理原因 和衰老的心理社会过程一样，老年人具有独特的创伤护理需求。不幸的是，目前的指导方针 创伤护理和紧急医疗服务 (EMS) 无法充分满足这些需求。院前急救的影响 健康结果护理在治疗受伤老年人的文献中存在巨大差距。 大约 10% 的受伤老年人在院前间隔期间接受阿片类镇痛药物进行疼痛管理， 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，阿片类药物引起的疼痛 药物是神经活性药物，可以扰乱大脑活动，增加谵妄的风险并恶化健康状况 结果。无论通过哪种途径，院前阿片类镇痛给药对短期和长期镇痛都具有深远的影响。 受伤老年人的长期健康和功能状态。这份针对国家老龄化研究所的申请 指导研究科学家发展奖 (K01) 寻求对新外科讲师 Molly Jarman 博士的支持 在布莱根妇女医院外科和公共卫生中心工作，渴望从事以下领域的职业 提高老年人院前急救和创伤护理系统的质量、有效性和可及性 美国的人口。贾曼博士之前的研究重点是伤害死亡率的地理决定因素 以及获得创伤中心护理的机会。为了扩大这项研究的影响和实际应用，贾曼博士提出 将她的研究转向老年创伤结果，解决针对优化创伤护理的新兴需求 美国人口老龄化。因此，K01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，以及因果推断和经济分析的统计方法。这 拟议的研究将采用先进的分析方法来仔细检查院前疼痛的影响 管理干预。研究目标将包括 (1) 评估影响 EMS 使用院前急救的因素 用于受伤老年人的阿片类镇痛，(2) 与院前阿片类药物相关的短期和长期健康结果 镇痛，以及 (3) 估计以下患者受伤后第一年的医疗保险支出： 没有院前疼痛管理。这项工作的实际应用将为国家、州、 以及寻求在院前期间为受伤老年人提供适当护理的当地急救中心领导人， 包括实践指南的变更以及对 EMS 基础设施和/或人员培训的投资。通过提供 薪资支持、培训、免于行政责任以及正式的导师结构，该奖项将 促进贾曼博士过渡到专注于改善健康结果和功能的独立研究职业 受伤老年人的状况。