Pharmacological Management of Pain in Alzheimer's Disease and Related Dementia

摘要：我的职业目标是成为一名独立的老年药物流行病学家， 疼痛和衰老领域的药物治疗质量测量和结果评估。临床 我的研究重点集中在老年人多发病的管理，特别是， 精神和身体疾病相互作用及其治疗。健康问题组合的一个例子是 患有阿尔茨海默病和相关痴呆症（ADRD）并且还患有慢性 痛苦迄今为止，关于止痛药处方质量和患者疼痛控制不良后遗症的数据 与ADRD是稀缺的。调查这些关联的研究受到样本量小的限制， 试图确定适当的疼痛控制对预防心理健康（MH）障碍的影响。的 我提出的K01研究的目标是提供初步数据，以提高我们对当前 疼痛药物处方和实践与疼痛指南之间的潜在差异，以及 为未来关于疼痛控制在减少ADRD中MH问题中的作用的研究制定假设。 我们提出了一个纵向设计，使用4年（2011 - 2014）的医疗保险5%的样本，其账单记录是 链接到养老院居民评估数据（最小数据集，MDS，3.0）。因为不清楚 MDS 3.0是否能准确检测出疼痛和MH障碍患者，我们首先进行可行性研究 验证MDS的疼痛，抑郁和行为症状对医疗记录在两个护理 家园（目标1）。通过全国代表性的Medicare-MDS数据，我们探讨了 药物疼痛管理及其在ADRD和非ADRD居民中的决定因素， 癌症疼痛（目标2）。质量将根据五个常见的临床标准进行检查-止痛药 选择，止痛药治疗计划，药物不良事件的药理学预防，禁忌症 药物使用和整体疼痛控制。然后，我们探索疼痛控制与疼痛相关的程度。 降低某些精神分裂症疾病的风险，包括抑郁、行为症状、焦虑和睡眠 ADRD疾病（目标3）。这个项目是为我量身定做的，以应用知识和技能，将 从我的主要导师Almut Winterstein博士（药物流行病学、质量 测量和结果评估）和共同导师：Roger Fillingim博士（疼痛），Marco Pahor（衰老）， Babette Brumback（纵向数据的先进方法）和Laurence Solberg（临床老年护理和 评估）。为了得到进一步的指导，我请了齐格弗里德施密特医生在疼痛医学领域的专业知识 和ADRD的史蒂文·德科斯基医生这个K01奖励将为我提供受保护的时间来接受培训 需要准备R01拨款申请，以检查止痛药的做法及其对健康的影响 ADRD的结果。这项研究的结果有望带来更好的药理学疼痛 管理和改善疼痛和健康结果的老年人认知障碍。

Summary: My career goal is to become an independent geriatric pharmacoepidemiologist with expertise in pharmacotherapy quality measurement and outcomes evaluation in the fields of pain and aging. The clinical focus of my research has centered on the management of multi-morbidity in older adults and particularly, the interplay of mental and physical disease and its treatment. One example of combination of health problems is elderly patients who live with Alzheimer's disease and related dementia (ADRD) and also suffer from chronic pain. To date, data on quality of pain medication prescribing and the sequelae of poor pain control in patients with ADRD are scarce. Studies investigating these associations are limited by small sample size, and none has attempted to establish the effect of adequate pain control on preventing mental health (MH) disorders. The goal of my K01 proposed research is to provide preliminary data that improve our understanding of current pain medication prescribing and potential discrepancies between practices and pain guidelines, and to formulate hypotheses for future research regarding the role of pain control in reducing MH problems in ADRD. We propose a longitudinal design using 4 years (2011-2014) of Medicare 5% sample whose billing records are linked to nursing home resident assessment data (Minimum Data Set, MDS, 3.0). Because it is unclear whether MDS 3.0 can accurately detect patients with pain and MH disorders, we first conduct a feasibility study of validating MDS-based pain, depression, and behavioral symptoms against medical records at two nursing homes (Aim 1). With the nationally representative Medicare-MDS data, we explore the quality of pharmacological pain management and its determinants among ADRD and non-ADRD residents with non- cancer pain (Aim 2). The quality will be examined based on five common clinical standards--pain medication selection, pain medication scheduling, pharmacological prevention of drug adverse event, contraindicated medication use, and overall pain control. We then explore the extent to which pain control is associated with a decreased risk for select MH disorders, including depression, behavioral symptoms, anxiety, and sleep disorders in ADRD (Aim 3). This project is well tailored for me to apply the knowledge and skills that will be obtained from training activities with my Primary Mentor, Dr. Almut Winterstein (pharmacoepidemioloy, quality measurement and outcome assessment) and Co-Mentors: Drs. Roger Fillingim (pain), Marco Pahor (aging), Babette Brumback (advanced methods for longitudinal data), and Laurence Solberg (clinical geriatric care and assessment). For further guidance, I enlist the expertise of Dr. Siegfried Schmidt in the field of pain medicine and Dr. Steven DeKosky in ADRD. This K01 award will provide protected time for me to receive training needed to prepare an R01 grant application to examine pain medication practices and their impact on health outcomes in ADRD. The results from this line of research are expected to lead to better pharmacological pain management and improved pain and health outcomes in older adults with cognitive impairments.