Variations in nursing home residents' depression by level of cognitive impairment

项目概要/摘要 大约有140万老年人住在养老院。大多数养老院的居民 中度或重度认知障碍。认知障碍会对各种健康产生负面影响 结果。联邦精准医学计划强调需要确定特定的亚组， 响应量身定制的干预措施，并最终为临床医生提供必要的知识和工具， 最适合个体患者独特需求的治疗方法。使用全面的纵向 数据集，拟议的研究将采用一种新的分析方法来评估认知的作用， 对疗养院居民中一种选定的常见疾病--抑郁症的损害。异构 抑郁症的症状确实会损害认知功能。抑郁症的治疗方法是 国家老龄化研究所作为一种潜在的预防认知障碍和促进健康老龄化的方法。 我们建议使用与Medicare Part A相关的国家联邦授权的最小数据集（MDS）3.0， D声称数据：1）确定养老院居民中抑郁症的亚组，并评估这些亚组是否存在抑郁症。 亚组因认知障碍状态而不同; 2）描述这些亚组在整个过程中的变化 护理之家住宿，并估计这些变化因认知障碍水平而异的程度;以及 3)估计抗抑郁药治疗效果在已确定的抑郁症亚组中的差异程度 以及认知障碍的程度用因果推理方法进行潜在类和潜在转移分析 将用于这项建议涉及国家老龄化研究所的战略研究方向， 通过制定干预措施，预防或减少 与年龄有关的疾病的负担（目标C）和增加对大脑老化的了解， 神经变性（目标D）。这项探索性研究将提供有价值的信息， 医疗工作，并改善对最需要的人口的护理过程。

PROJECT SUMMARY/ABSTRACT Approximately 1.4 million older adults live in nursing homes. The majority of nursing home residents have moderate or severe cognitive impairment. Cognitive impairment can negatively impact a variety of health outcomes. The federal Precision Medicine initiative highlights the need to identify specific subgroups that respond to tailored interventions and ultimately provide clinicians with knowledge and tools necessary to select treatments that work best for the unique needs of an individual patient. Using a comprehensive longitudinal dataset, the proposed research will employ a novel analytic approach to evaluate the role of cognitive impairment on a selected common condition in nursing home residents -- depression. The heterogeneous symptoms of depression can indeed impair cognitive functioning. Depression treatment has been identified by the National Institute on Aging as a way to potentially prevent cognitive impairment and promote healthy aging. We propose using the national federally-mandated Minimum Data Set (MDS) 3.0 linked to Medicare Part A and D claims data to: 1) identify subgroups of depression among nursing home residents and evaluate if these subgroups differ by cognitive impairment status; 2) characterize how these subgroups change throughout the nursing home stay and estimate the extent to which these changes differ by level of cognitive impairment; and 3) estimate the extent to which antidepressant treatment effects vary across identified subgroups of depression and levels of cognitive impairment. Latent class and latent transition analyses with causal inference methods will be used. This proposal addresses the National Institute on Aging’s strategic research directions on how to improve the health and well-being of adults as they age by developing interventions for preventing or reducing the burden of age-related conditions (Goal C) and increasing knowledge of the aging brain and neurodegeneration (Goal D). This exploratory research will provide valuable information to inform precision medicine efforts and improve the processes of care to a population most in need.