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Clinically Significant Drug Interactions among Nursing Home Residents with ADRD

患有 ADRD 的疗养院居民中具有临床意义的药物相互作用

基本信息

批准号：
10448110
负责人：
Andrew Reis Zullo
金额：
$ 71.13万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10448110
关键词：
Accounting Address Adverse drug event Adverse event Affect Alzheimer&apos s disease related dementia Cessation of life Clinical assessments Computer software Dangerousness Data Data Set Databases Dose Drug Interactions Drug Prescriptions Drug usage Elderly Electronic Health Record Fatigue Fracture Future Goals Health Insurance Health Personnel Hemorrhage Hospitalization Ice Impaired cognition Individual Injury Joint Dislocation Lead Link Medical Medicare Medicare claim Medication Management Methodology Methods Morbidity - disease rate National Institute on Aging Nature Nursing Homes Outcome Pain Pharmaceutical Preparations Polypharmacy Population Provider Randomized Clinical Trials Records Regimen Research Research Personnel Risk Risk Factors Screening Result Series Subgroup Symptoms Testing Time Triad Acrylic Resin Validation adverse outcome analytical method base clinical practice clinically actionable clinically significant data resource disability epidemiology study exhaustion fall injury fall risk falls frailty high risk improved innovation modifiable risk multidisciplinary multiple chronic conditions novel novel therapeutics risk minimization screening validation studies

项目摘要

PROJECT SUMMARY Polypharmacy is common among nursing home (NH) residents and is most prevalent among residents with Alzheimer's Disease and Related Dementias (ADRD) due to their high burden of multiple chronic conditions that predispose them to medication use. Polypharmacy is dangerous for NH residents with ADRD because it substantially increases the risk of drug interactions. Fall-related injuries, including fractures, joint dislocations, and hemorrhages, are one of the most common and impactful adverse outcomes of drug interactions and result in morbidity, disability, and death. Many theoretical interactions between drugs have been identified and healthcare providers believe that drug interactions are common and harmful among older NH residents with ADRD, yet limited data exist about which interactions are most clinically significant. Given that drug interactions resulting from polypharmacy are likely a major, yet modifiable, cause of fall-related injuries among older NH residents with ADRD, identifying drug interactions and their effects is essential for avoiding fall-related injuries. Thus, the overall objective of this proposal is to identify, test, and validate clinically significant drug interactions in NH residents with ADRD through a series of rigorous epidemiological studies that employ novel drug interaction screening and causal inference methods. The central hypothesis is that multiple clinically significant drug interactions will increase the risk of fall-related injuries, and that this risk will be greatest among individuals with the most severe cognitive impairment and on higher medication doses. This hypothesis will be tested through three specific aims: Aim 1 (Screening), Conduct hypothesis-free high-throughput semi-automated screening to identify potential interactions involving drug pairs and triads that increase the risk of fall-related injuries among NH residents with ADRD; Aim 2 (Testing), After prioritizing interaction screening results with the guidance of a multidisciplinary expert stakeholder panel, perform a series of hypothesis-driven studies to quantify the effects of drug interactions on fall-related injuries, including dose, duration, and NH resident subgroup effects; and Aim 3 (Replication), Conduct a series of validation studies in independent data to determine whether the drug interactions identified during screening and testing are consistently associated with fall-related injuries among NH residents with ADRD. To accomplish the three proposed aims, a large novel database of NH electronic health record information be leveraged along with national MDS 3.0 clinical assessment records linked to Medicare health insurance and prescription drug claims. The proposed research is highly significant because it will provide clinically actionable empirical evidence to help guide the prescribing, deprescribing, and management of medications to minimize the risk of important drug interactions and fall-related injuries among NH residents with ADRD. This proposal is directly responsive to PAR-19-070 and advances the National Institute on Aging's Strategic Goal C to improve the safe use of medications.

项目总结多药联用在疗养院(NH)居民中很常见，在患有阿尔茨海默病和相关痴呆症(ADRD)是由于他们的多种慢性疾病造成的高负担使他们易于用药。多药联用对患有ADRD的NH居民来说是危险的，因为它大大增加了药物相互作用的风险。与跌倒有关的伤害，包括骨折，关节脱位，和出血，是药物相互作用和结果最常见和影响最大的不良后果之一在发病率、伤残和死亡方面。已经确定了许多药物之间的理论相互作用，并医疗保健提供者认为，药物相互作用在老年NH居民中很常见，而且有害 ADRD，然而，关于哪些相互作用最具临床意义的数据有限。鉴于药物之间的相互作用服用多药可能是老年NH中与跌倒相关的伤害的主要原因，但可以改变对于患有ADRD的居民来说，识别药物相互作用及其影响对于避免与跌倒相关的伤害至关重要。因此，该提案的总体目标是识别、测试和验证临床上有意义的药物相互作用。通过使用新药的一系列严格的流行病学研究，在患有ADRD的NH居民中交互作用筛选和因果推理方法。中心假设是多个具有临床意义的药物相互作用将增加与跌倒相关的伤害的风险，而且这种风险在个人中最大有最严重的认知障碍和更高的药物剂量。这一假设将得到检验。通过三个具体目标：目标1(筛选)，进行无假设的高通量半自动筛查以确定涉及毒品对和三合会的潜在相互作用，这些相互作用会增加跌倒相关的风险 NH居民中患有ADRD的伤害；AIM 2(测试)，在与在多学科专家利益相关者小组的指导下，执行一系列假设驱动的研究以量化药物相互作用对跌倒相关伤害的影响，包括剂量、持续时间和NH居民亚组效应；和Aim 3(复制)，在独立数据中进行一系列验证研究，以确定在筛选和测试过程中发现的药物相互作用始终与跌倒相关的伤害有关在患有ADRD的NH居民中。为了实现上述三个目标，建立了一个大型的NH新型数据库利用电子健康记录信息与国家MDS 3.0临床评估记录链接医疗保险和处方药索赔。拟议的研究具有非常重要的意义，因为它将提供临床上可操作的经验证据，以帮助指导处方、停药和对药物的管理，以最大限度地减少重要药物相互作用和跌倒相关伤害的风险患有ADRD的NH居民。这项建议直接响应PAR-19-070，并推动了国家研究所关于老龄化的战略目标C，即提高药物使用的安全性。