The Causes and Consequences of Risky Prescribing

项目摘要--项目2 在过去的几十年里，处方药以惊人的好处改变了患者的护理，但他们的 使用也会带来风险；对老年人来说尤其如此。我们建议共同研究三个问题- 处方但有潜在风险的药物组(阿片类镇痛剂、苯二氮卓类和非苯二氮卓类 镇静催眠药)。我们将探索这些药物的使用是如何随着时间的推移而变化的，以及它们的单独使用是如何 或两者结合，与重要的健康后果有关，包括跌倒、机动车事故、骨折和 服药过量事件。近老年人、老年人和老年人对强力药物不良反应的敏感性 高龄老年人的这些物质的研究对于我们理解老年人的健康状况至关重要 安全配置文件。但是，这些药物对于高质量、仁慈的疼痛、极端 焦虑和空气饥饿可作为生命末期经历以及许多急性和慢性健康的特征 条件；因此，使用不足可能与过度使用一样繁重。我们的建议有四个目标：目标1：描述 老年人接受危险药物的模式，包括阿片类镇痛剂、苯二氮卓类药物、镇静催眠药。 目的2：评估与老年人接受危险药物有关的结果。目标3：探索临床医生、健康 系统，以及与潜在危险处方相关的外部因素。目标4：利用自然资源 确定危险处方模式的可信原因和可信的因果关系的实验 在不良健康事件中使用处方药。因为我们预计这些药物会产生不同的影响 在不同的种群中，每个目标都将检查总体种群以及具有可行性的子种群 由于生物因素的不同脆弱性；我们将专门研究药物接收、结果和预测因素 按年龄、性别、种族/族裔、贫困、长期护理居住地和患病情况界定的群体，包括 痴呆症和行为健康状况。该提案涉及NIA的优先研究领域，包括 50岁及以上成年人使用大麻、处方阿片类药物和苯二氮卓类药物的情况 差异和少数民族老龄化问题，“”并存疾病的相互作用，这些疾病的治疗方法，以及 优化老年多发性骨髓瘤患者利益与风险平衡的干预措施的有效性 条件，以及，在我们计划的分组分析中，与阿尔茨海默病相关的社会科学研究 以及相关的痴呆症。

PROJECT SUMMARY – PROJECT 2 Prescription drugs have transformed patient care over the last several decades with stunning benefits, but their use has also conferred risks; this is especially true for the elderly. We propose to study three commonly- prescribed but potentially risky groups of drugs (opioid analgesics, benzodiazepines, and non-benzodiazepine sedative hypnotics). We will explore how use of these drugs has changed over time and how their use, alone or in combination, is related to important health outcomes including falls, motor vehicle accidents, fractures and overdose events. Heightened susceptibility to the adverse effects of powerful drugs among near old, old, and very old adults makes study of these substances in aging populations essential to our understanding of their safety profile. But, these same drugs are important to high-quality, merciful management of pain, extreme anxiety and air hunger that can characterize end of life experience as well as many acute and chronic health conditions; underuse thus may be as burdensome as overuse. Our proposal has four aims: Aim 1: To describe patterns of risky drug receipt by the elderly, including opioid analgesics, benzodiazepines, sedative hypnotics. Aim 2: To measure outcomes related to risky drug receipt by the elderly. Aim 3: To explore clinician, health system, and external factors associated with potentially hazardous prescribing. Aim 4: To leverage natural experiments to identify plausible causes of hazardous prescribing patterns and plausibly causal effects of prescription drug use on adverse health events. Because we anticipate heterogeneous effects of these drugs in distinct populations, each aim will examine the overall population as well as sub-populations with feasible diverse vulnerabilities due to biologic factors; we will specifically study drug receipt, outcomes and predictors in groups defined by age, sex, race/ethnicity, poverty, long-term care residence and morbidities, including dementia and behavioral health conditions. This proposal addresses NIA priority research areas including “aspects of marijuana and prescription opioid and benzodiazepine use in adults aged 50 and older,” “health disparities and minority aging issues,” “interactions of comorbid conditions, therapies for these conditions, and the efficacy of interventions to optimize the balance of benefits and risks for the older patient with multiple conditions,” and, in our planned subgroup analyses, “social science research related to Alzheimer’s disease and related dementias.”