Longitudinal Impact of CNS Polypharmacy on Geriatric Sy*

由于来自不同类别的药物具有相似的Pharmacol- 在老年人中，逻辑上的副作用是令人担忧的。CNS综合药房是一个常见而重要的例子 这种现象。中枢神经系统多药联用可能有助于老年综合征的发展。 认知障碍、尿失禁和活动/不稳定问题等症状也是 对于老年人来说，这很常见、病态和昂贵。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性综合征的影响的信息。这个 长期目标是通过确定随时间推移的动态影响来增强老年人的健康 中枢神经系统综合药房对老年综合征的暴露和变化，以便设计干预措施， 健康结果得到改善，医疗成本降低。采用纵向设计，即时 目的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。 药学将被定义为：1)使用来自六种药物类别中的任何一种的2种或更多药物(即， 苯二氮类药物、其他抗焦虑药物/催眠药、阿片类止痛药、抗抑郁药、抗精神病药物和抗精神病药物 癫痫药物)和2)这些多种中枢神经系统药物的联合标准每日剂量。我们将决定 移动/不稳定性能(例如，EPESE下肢电池、400米步行、平衡、自我报告 (如跌倒)、认知功能(即3MS)和自我报告的尿失禁。具体的假设是 测试的结果是，与未受影响的老年人相比，患有疾病的老年人、事件和 越来越多的中枢神经系统药物将导致更大的机动性/不稳定性下降，认知能力下降，以及 在控制了重要的协变量(例如，合并症)后，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。目前的提案可能会 具有很高的成本效益，可以预期产生的结果是有效的，可推广到老年人。

Multiple drug use or polypharmacydue to medications from different classes that share similar pharmacol- ogical side effects is of concern in older adults. CNS polypharmacy is a commonand important exampleof 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 costlyfor older adults. With the trend towards increased use of medications, information is needed regarding the impact of CNS polypharmacy on geriatric syndromesin older adults. The long term objectiveis 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 polypharmacyon 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.