Deprescribing Central Nervous System Medications in Hospitalized Older Adults

这个K23职业发展奖在老龄化的重点是博士的发展。 老年病学家，以及减少住院老年人中枢神经系统（CNS）药物的使用。 博士Pavon的长期目标是提高老年人对急性压力源的适应力， 住院她已经建立了她的研究计划，调查住院的危害，和一个主要的 威胁是高风险的药物暴露。住院期间次优的CNS药物使用是关键 不良健康结果的可改变风险因素;常见类别包括阿片类药物，抗焦虑药，抗抑郁药， 抗精神病药和催眠药。我们的初步数据表明，近40%的住院老年人 在他们住院期间暴露于抗焦虑药和60%的阿片类药物。取消处方是一个系统的过程， 减少或减少药物。促进取消针对特定药物的处方的干预措施 类，如中枢神经系统药物，或特定人群，如那些现有的认知障碍，还没有 在住院病人中得到了很好的研究。这一差距是一个关键的机会，可以减少潜在的 不适当的中枢神经系统药物及其使脆弱患者衰弱的副作用-符合国家 老龄化研究所的优先事项，以改善老年人的药物使用。Pavon博士的K23奖旨在 开发和试点测试一个去处方干预，是由一个理论模型的行为 变化目标1的结果将告知问题的流行病学，并确定目标人群， 招聘目标2将使用定性方法来研究医院取消处方的障碍和促进因素。 结果将为最适合促进CNS药物处方的干预提供策略提供信息， 一种宽容的可行的方式目标3将开发和试点测试一个多组成部分的医院为基础的德， 规定使用健康信息学进行内容交付的干预措施，以及提供者行为的改变， 患者激活策略。这项工作将促进对1）哪些患者和CNS药物的理解 取消处方干预措施的目标类别，2）是否有独特的障碍， 医院设置，和3）安全地取消处方的最佳交付策略。在此期间，K23博士。 Pavon还将完成马尔可夫建模统计技术，干预， 发展、健康信息学和领导力。Pavon博士的导师团队将提供科学支持， 在老龄化，药理学，医院医学和研究方法的专业知识。这种职业发展 该计划将给予Pavon博士在医院环境中进行干预开发研究的技能。 该培训和由此产生的数据将使Pavon博士成为R 01干预措施的有力候选人， 促进近1/2的老年人取消CNS药物处方，这些老年人将暴露于 在住院期间使用CNS药物。

This K23 Career Development Award in Aging focuses on the development of Dr. Juliessa Pavon, a hospital- based geriatrician, and on reducing central nervous system (CNS) medication use in hospitalized older adults. Dr. Pavon’s long-term goal is to improve the resilience of older adults against the acute stressors of hospitalization. She has built her research program on investigating hazards of hospitalization, and a major threat is high-risk medication exposure. Sub-optimal CNS medication use during hospitalization is a key modifiable risk factor for poor health outcomes; common classes include opioids, anxiolytics, anti-depressants, antipsychotics, and hypnotics. Our preliminary data suggests that nearly 40% of hospitalized older adults are exposed to anxiolytics and 60% to opioids during their hospital stay. De-prescribing is a systematic process of tapering or reducing medications. Interventions to facilitate de-prescribing that target specific medication classes, like CNS medications, or specific populations, like those with existing cognitive impairment, have not been well-studied in the inpatient setting. This gap represents a key opportunity to reduce potentially inappropriate CNS medications and their debilitating side effects in vulnerable patients--in line with the National Institute of Aging’s priorities to improve medication use in older adults. Dr. Pavon’s K23 award proposes to develop and pilot test a de-prescribing intervention that is informed by a theoretical model of behavioral change. Aim 1 results will inform the epidemiology of the problem and identify target populations for recruitment. Aim 2 will use qualitative methods to examine barriers and facilitators of hospital de-prescribing. Results will inform the intervention delivery strategies best suited to facilitate CNS medication de-prescribing in a well-tolerated, feasible manner. Aim 3 will develop and pilot test a multi-component hospital-based de- prescribing intervention that uses health informatics for content delivery, and provider behavior change and patient activation strategies. This work will advance understanding of 1) which patients and CNS medication classes to target for de-prescribing interventions, 2) whether there are unique barriers to de-prescribing in the hospital setting, and 3) the optimal delivery strategy for safely de-prescribing. During this K23 grant period, Dr. Pavon will also complete additional training in Markov modeling statistical techniques, intervention development, health informatics, and leadership. Dr. Pavon’s mentor team will provide scientific support with expertise in aging, pharmacology, hospital medicine, and research methodology. This career development plan will give Dr. Pavon the skills in conducting intervention development studies within the hospital setting. This training and resulting data will establish Dr. Pavon as a strong candidate for an R01 intervention designed to facilitate de-prescribing of CNS medications for the nearly 1 in 2 older adults that will experience exposure to a CNS medication during hospitalization.