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Perioperative Medication Use, Post-operative Delirium, and Cognition in Older Adults Undergoing Elective Non-Cardiac Surgery

接受择期非心脏手术的老年人围手术期药物使用、术后谵妄和认知

基本信息

批准号：
9911310
负责人：
Matthew Steven Duprey
金额：
$ 3.64万
依托单位：
NORTHEASTERN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-12 至 2020-09-11
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9911310
关键词：
Acute Admission activity Adrenergic beta-Antagonists Adult Adverse event Affect Aging American Anti-Cholinergics Antipsychotic Agents Benzodiazepines Biological Cardiac Surgery procedures Caring Chronic Clinical Data Cognition Cognitive Collaborations Collection Communities Complex Critical Illness Data Delirium Dementia Development Disease Drug Interactions Drug usage Elderly Ensure Epidemiology Evaluation Fellowship Foundations Funding Future Health Healthcare Hospitalization Hospitals Impaired cognition Individual Lead Length of Stay Memory Mentorship Mission Nerve Degeneration Non-Steroidal Anti-Inflammatory Agents Operative Surgical Procedures Opioid Opioid Analgesics Outcome Outcome Study Outpatients Oxidoreductase Patients Perioperative Pharmaceutical Preparations Polypharmacy Population Postoperative Period Property Prospective cohort study Publishing Recovery of Function Regimen Reporting Research Research Personnel Risk Risk Factors Role Scientific Inquiry Specimen Statistical Models Substance Withdrawal Syndrome Training Universities Vulnerable Populations Work adverse event risk cognitive change cognitive function cohort comorbidity demographics design executive function experience follow-up high risk improved improved outcome indexing inhibitor/antagonist innovation medical schools medication administration model design modifiable risk mortality neuroimaging pharmacokinetics and pharmacodynamics postoperative delirium predictive modeling prescription opioid prospective sedative skills therapy design

项目摘要

Project Summary Older adults are at high risk for polypharmacy particularly during transitions of care; use of potentially inappropriate medications may lead to adverse events and drug-related hospital admissions. Postoperative delirium, occurring in up to 56% of older adults undergoing surgery, is associated with longer hospital stays, increased mortality at 30 days, and reduced functional recovery. Medication regimen alterations before and after surgery prior to hospital discharge may increase postoperative delirium and influence longer-term cognition. Accurate recognition of medication-associated risk factors for postoperative delirium in the older adult surgical population is critical when defining targets for deprescribing efforts. Despite the prevalent use of potentially deliriogenic medications in the older adult surgical population, their association with postoperative delirium is poorly researched and effect on longer-term cognition unknown. The proposed research aims to investigate the impact of medications administered prior to surgery and during the in-hospital period immediately following surgery on the development of delirium and subsequent changes in cognition. This will be accomplished through the creation of robust statistical models, designed in collaboration with leading researchers in the fields of delirium and aging, controlling for established baseline predictors for postoperative delirium and the effects of all administered medications. When investigating the association between pre- and post-surgery medication use and longer-term cognition, the occurrence of intervening delirium will be accounted for given the independent effect that delirium alone may have on cognitive decline. The outcome of this work will have an immediate impact in the scientific community by informing postoperative delirium reduction efforts and deprescribing initiatives. It will also guide future research on the risk factors for both postoperative delirium and longer-term cognitive decline in the older adult surgical population. This proposed project, overseen by leading researchers at Northeastern University and Harvard Medical School, is in line with the NIA’s mission to understand and improve health among aging populations. Not only will this research help improve our understanding of the complex interplay between medications and the neurodegeneration experienced with delirium, but it will also inform future interventions designed to improve health among aging populations. All of this work will be completed through a training and mentorship plan that has been thoughtfully-developed by an interdisciplinary group of senior NIA-funded researchers that will provide an important foundation for additional independent scientific inquiry. Through their collective expertise, the sponsor team will share the skills and experience necessary to ensure the applicant excels not only in this proposed fellowship but also in his transition to a role as an independent researcher.

项目摘要老年人服用多药的风险很高，特别是在护理过渡期间；使用潜在的不适当的用药可能会导致不良事件和与药物有关的住院治疗。术后在接受手术的老年人中，高达56%的人会出现精神错乱，这与住院时间较长有关， 30天后死亡率增加，功能恢复减少。服药前和服药方案的变化手术后出院前可能会增加术后精神错乱，影响远期认知力。准确认识老年人术后精神障碍的用药相关危险因素成人手术人群在确定停药努力的目标时是至关重要的。尽管普遍使用老年外科手术人群中潜在的致幻药物及其与术后的关系精神错乱的研究很少，对长期认知的影响也不清楚。这项拟议的研究旨在调查手术前和手术前服用药物的影响。在手术后立即住院期间发展为神志不清及随后的认知上的变化。这将通过创建稳健的统计模型来实现，该模型设计于与精神错乱和衰老领域的领先研究人员合作，控制既定的基线术后精神错乱的预测因素和所有用药的效果。在调查的时候术前术后用药与长期认知功能障碍的关系介入性精神错乱将考虑到精神错乱单独对认知能力下降。这项工作的成果将在科学界产生立竿见影的影响告知术后减少精神错乱的努力和停药倡议。它还将指导未来的研究老年人外科术后精神障碍和长期认知功能减退的危险因素研究人口。这项拟议的项目由东北大学和哈佛医学院的主要研究人员监督这与NIA了解和改善老龄人口健康的使命是一致的。不仅这项研究将有助于我们更好地理解药物和药物之间的复杂相互作用精神错乱所经历的神经变性，但它也将为未来旨在改善的干预措施提供信息老龄化人口中的健康问题。所有这些工作都将通过培训和指导计划来完成由NIA资助的高级研究人员组成的跨学科小组深思熟虑地开发出来的，将为其他独立的科学研究提供了重要的基础。通过他们的集体专业知识，赞助商团队将分享必要的技能和经验，以确保申请者不仅在这方面出类拔萃他提出了奖学金，但也是在他向独立研究人员的角色过渡过程中。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Association Between Incident Delirium Treatment With Haloperidol and Mortality in Critically Ill Adults.

DOI：
10.1097/ccm.0000000000004976
发表时间：
2021-08-01
期刊：
Critical care medicine
影响因子：
8.8
作者：
Duprey MS;Devlin JW;van der Hoeven JG;Pickkers P;Briesacher BA;Saczynski JS;Griffith JL;van den Boogaard M
通讯作者：
van den Boogaard M

Is there an association between subjective sleep quality and daily delirium occurrence in critically ill adults? A post hoc analysis of a randomised controlled trial.

危重成人的主观睡眠质量与每日谵妄发生率之间是否存在关联？