Antidementia medication use, safety, and effectiveness among nursing home residents with Alzheimer's disease

患有阿尔茨海默病的疗养院居民的抗痴呆药物使用、安全性和有效性

基本信息

批准号：
10399574
负责人：
Matthew Alcusky
金额：
$ 78.7万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10399574
关键词：
Acute Address Admission activity Adverse drug event Alzheimer&apos s Disease Alzheimer&apos s disease diagnosis American Anti-Cholinergics Antidepressive Agents Antipsychotic Agents Behavioral Symptoms Cardiovascular system Caring Cause of Death Characteristics Cholinesterase Inhibitors Clinical Clinical Trials Cognitive Combined Modality Therapy Communities Comparative Study Conduct Clinical Trials Data Data Set Data Sources Decision Making Dementia Diarrhea Disease Distant Dose Drug usage Effectiveness Elderly Eligibility Determination Event Fracture Galantamine Goals Hospitalization Impaired cognition Kidney Learning Link Longitudinal Studies Measures Medicare Medicare Part A Memantine Minority National Institute on Aging Nursing Homes Outcome Patients Pattern Persons Pharmaceutical Preparations Polypharmacy Population Prevalence Process Psychotropic Drugs Public Health Quality of Care Quality of life Research Risk Safety Severities Therapeutic Time Vomiting advanced disease aged clinical risk cognitive function comorbidity crosslink daily functioning design disability-adjusted life years donepezil effectiveness evaluation effectiveness outcome end stage disease evidence base fall risk falls follow-up functional status high risk improved instrument mortality nursing home length of stay rivastigmine safety outcomes sedative virtual years of life lost

项目摘要

PROJECT SUMMARY/ABSTRACT This proposal is responsive to PA-17-088. The number of Americans living with Alzheimer’s disease is projected to more than double from 5.6 million in 2019 to 13.8 million by 2050. This rise in Alzheimer’s disease prevalence represents a serious public health concern. In 2019, Alzheimer’s disease was estimated to be the sixth leading cause of death in the US and the fourth leading cause of disability adjusted life years lost. Half of the nursing home population has a diagnosis of Alzheimer’s disease or another dementia. Only two available classes of medications, cholinesterase inhibitors (ChEIs) and memantine have been demonstrated to slow symptomatic progression of Alzheimer’s disease. Donepezil (the most widely used ChEI) has FDA indications for mild, moderate, and severe Alzheimer’s disease, while memantine is indicated for moderate to severe Alzheimer’s disease and has evidence supporting possible benefits in mild disease. Only ~40% of residents were treated with either medication class at the time of nursing home admission historically (2006), and a small minority (10%) received combination therapy. Nursing home residents may be at higher risk for adverse drug events from drug- drug and drug-disease interactions due to a high burden of polypharmacy and comorbidities. Yet in the DOMINO clinical trial conducted among community dwelling patients, discontinuation of a ChEI before the end stages of the disease was associated with worse clinical outcomes. Nearly a quarter of nursing home residents treated with ChEIs and/or memantine at the time of admission discontinued treatment shortly after admission (regardless of dementia severity) and were potentially at risk for clinical worsening and the need to use more hazardous drugs such as antipsychotics. Using contemporaneous, national, federally-mandated Minimum Data Set 3.0 linked to Medicare Part A and D claims, study aims are to: 1) examine contemporary patterns of ChEI, memantine, and psychotropic medication use in NH residents with Alzheimer’s disease; 2) compare long-term effectiveness, safety, and survival between residents initiating combination therapy, monotherapy, and no treatment with ChEIs and memantine; and 3) identify resident characteristics (e.g., dosing, comorbid conditions, concurrent medications, dementia stage) for whom treatment with ChEIs and/or memantine confers a net clinical benefit. The proposed R01 is responsive to calls for well-designed long-term studies of ChEIs and memantine. By expanding the evidence base to facilitate a dynamic resident-centered decision-making process regarding Alzheimer’s disease treatment in an aged nursing home population, this proposal fulfills the goals of The National Plan to Address Alzheimer’s Disease to effectively treat Alzheimer’s disease and to optimize care quality and efficiency. This research is also closely aligned with the National Institute on Aging’s Strategic Goal to improve the safe use of medications.

项目摘要/摘要该提案对PA-17-088的响应敏感。预计患有阿尔茨海默氏病的美国人人数预计从2019年的560万增加到2050年的1380万人。代表了一个严重的公共卫生问题。 2019年，阿尔茨海默氏病估计是第六位领先美国的死亡原因和残疾的第四个主要原因调整了终生损失。一半的护士家庭人口诊断为阿尔茨海默氏病或其他痴呆症。只有两个可用的类已经证明药物，胆碱酯酶抑制剂（CHEI）和美金刚蛋白阿尔茨海默氏病的进展。多奈替齐（使用最广泛的CHEI）的FDA适应症指示中度和严重的阿尔茨海默氏病，而纪念中等至重度的阿尔茨海默氏症疾病并有证据支持轻度疾病可能的益处。只有约40％的居民接受治疗在历史上接受护士住宅时的药物班（2006年），少数少数（10％）接受了组合疗法。养老院居民可能会因吸毒而面临广告毒品事件的风险较高 - 由于多药和合并症的高燃烧而引起的药物和药物疾病相互作用。但是在多米诺骨牌在社区住宅患者中进行的临床试验，在结束阶段之前停止了CHEI 该疾病与临床结局较差有关。将近四分之一的护士居民接受治疗入院时不久入院治疗时使用Cheis和/或美容（无论如何）痴呆症的严重程度），并有可能有临床担心的风险，并且需要使用更危险的抗精神病药等药物。使用现代，国家，联邦政府最低数据集3.0 与Medicare A部分和D主张有关，研究目的是：1）考试当代的CHEI模式， NH居民患有阿尔茨海默氏病的NH居民，美容和精神药物使用； 2）比较长期居民发射组合疗法，单一疗法和无用cheis和美容治疗； 3）确定居民特征（例如，剂量，合并条件，并发药物，痴呆阶段）用Cheis和/或美容治疗净临床治疗好处。拟议的R01响应呼吁对CHEIS和MEMANTINE进行精心设计的长期研究。通过扩大证据基础以促进以动态居民为中心的决策过程阿尔茨海默氏病治疗在老年护士家庭人口中，该提议实现了国家的目标计划解决阿尔茨海默氏病，以有效治疗阿尔茨海默氏病并优化护理质量和效率。这项研究也与国家老化研究所的战略目标紧密相符安全使用药物。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Antidementia Medication Use in Nursing Home Residents.

DOI：
10.1177/08919887231202948
发表时间：
2023-09
期刊：
Journal of Geriatric Psychiatry and Neurology
影响因子：
2.6
作者：
Brian R Ott;Carl Hollins;J. Tjia;Jonggyu Baek;Qiaoxi Chen;Kate L. Lapane;M. Alcusky
通讯作者：
Brian R Ott;Carl Hollins;J. Tjia;Jonggyu Baek;Qiaoxi Chen;Kate L. Lapane;M. Alcusky

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