Longitudinal Impact of CNS Polypharmacy on Geriatric Syn

描述（由申请人提供）：由于不同类别的药物具有相似的药理副作用而导致的多种药物使用或多种用药是老年人关注的问题。中枢神经系统多药是这种现象的一个常见而重要的例子。中枢神经系统多药可促进老年综合征的发展。老年综合症，如认知障碍、尿失禁和行动/不稳定问题，对老年人来说也是常见的、病态的和昂贵的。随着药物使用增加的趋势，需要有关中枢神经系统综合用药对老年人老年综合征影响的信息。长期目标是通过确定暴露时间的动态影响和中枢神经系统多药对老年综合征的变化来改善老年人的健康，以便设计干预措施，改善健康结果并降低保健费用。采用纵向设计，直接目标是确定随着时间的推移，中枢神经系统多药治疗对老年综合征的影响。中枢神经系统多药将被定义为：1)使用六种药物类别中的两种或两种以上的药物（即，苯二氮卓类药物，其他抗焦虑药/催眠药，阿片类镇痛药，抗抑郁药，抗精神病药和抗癫痫药）和2)这些多种中枢神经系统药物的标准化每日联合剂量。我们将确定患者的活动能力/不稳定性表现（即EPESE下肢电池、400米行走、平衡、自我报告跌倒）、认知功能（即3MS）和自我报告的尿失禁。需要检验的具体假设是，与未受影响的老年人相比，在控制了重要协变量（如合并症）后，中枢神经系统多药性普遍、偶发和增加的老年参与者将出现更大的活动能力/不稳定性下降、认知能力下降和尿失禁的可能性增加。这项研究利用了nia资助的纵向健康ABC研究的数据。目前的建议可能具有很高的成本效益，并有望产生有效和可推广到老年人的结果。

DESCRIPTION (provided by applicant): Multiple drug use or polypharmacy due to medications from different classes that share similar pharmacological side effects is of concern in older adults. CNS polypharmacy is a common and important example of this phenomenon. CNS polypharmacy may contribute to the development of geriatric syndromes. Geriatric syndromes such as cognitive impairment, urinary incontinence and mobility/instability problems are also common, morbid and costly for older adults. With the trend towards increased use of medications, information is needed regarding the impact of CNS polypharmacy on geriatric syndromes in older adults. The long term objective is to enhance the health of the elderly by determining the dynamic effects over time of exposure and changes in CNS polypharmacy on geriatric syndromes, so that interventions can be designed, health outcomes improved and health care costs reduced. Using a longitudinal design, the immediate objective is to determine the impact over time of CNS polypharmacy on geriatric syndromes. CNS poly- pharmacy will be defined as: 1) the use of 2 or more medications from any of six medication classes (i.e., benzodiazepines, other anxiolytics/ hypnotics, opioid analgesics, antidepressants, antipsychotics and anti- epileptics) and 2) combined standardized daily dosage of these multiple CNS medications. We will determine mobility/instability performance (i.e., EPESE lower extremity battery, 400 meter walk, balance, self-reported falls), cognitive function (i.e., 3MS), and self-reported urinary incontinence. The specific hypotheses to be tested are that, compared with non affected elders, elderly participants with prevalent, incident and increasing CNS polypharmacy will have greater mobility/instability decline, increased cognitive decline, and increased likelihood of urinary incontinence after controlling for important covariates (e.g. comorbidities).This study capitalizes on data from the NIA-funded longitudinal Health ABC study. The current proposal is likely to be highly cost-effective and can be expected to yield results that are valid and generalizable to older adults.