Longitudinal Impact of CNS Polypharmacy on Geriatric Syndromes

描述(由申请人提供)：由于来自不同类别的药物具有相似的药理副作用，导致多种药物使用或多药联用，这在老年人中是令人担忧的。CNS综合药房就是这种现象的一个常见和重要的例子。中枢神经系统多药联用可能有助于老年综合征的发展。老年综合征，如认知障碍、尿失禁和活动/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，需要关于中枢神经系统多药联用对老年人老年综合征的影响的信息。长期目标是通过确定随着时间的推移暴露和中枢神经系统多药系统对老年综合征的变化的动态影响来增强老年人的健康，以便能够设计干预措施，改善健康结果，降低医疗成本。采用纵向设计，近期目标是确定随着时间的推移，中枢神经系统多药联用对老年综合征的影响。中枢神经系统综合药房将被定义为：1)使用6种药物类别中的任何一种(即苯二氮卓类、其他抗焦虑/催眠药、阿片类止痛药、抗抑郁药、抗精神病药物和抗癫痫药)中的2种或2种以上药物；2)这些多种中枢神经系统药物的合并标准每日剂量。我们将确定活动/不稳定性能(即EPESE下肢电池、400米步行、平衡、自我报告的跌倒)、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，患有普遍、偶发和日益增多的中枢神经系统多药的老年参与者在控制了重要的协变量(如合并症)后，活动能力/不稳定程度下降、认知能力下降和尿失禁可能性增加。这项研究利用了NIA资助的纵向健康ABC研究的数据。目前的提议可能具有很高的成本效益，可以预期产生对老年人有效和可推广的结果。

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.