Deprescribing Central Nervous System Medications in Hospitalized Older Adults

本次K23老龄事业发展奖聚焦于Juliessa Pavon医生这一医院的发展- 以老年医生为基础，并减少住院老年人的中枢神经系统(CNS)药物使用。 Pavon博士的长期目标是提高老年人对急性应激源的韧性 住院治疗。她已经建立了她的研究计划，调查住院的危险，和一个主要的 威胁是高风险的药物暴露。住院期间使用次优的中枢神经系统药物是一个关键 不良健康结局的可改变的风险因素；常见的类别包括阿片类药物、抗焦虑药物、抗抑郁药物、 抗精神病药物和催眠药。我们的初步数据显示，近40%的住院老年人 在住院期间接触过抗焦虑药物和60%的阿片类药物。去处方药是一个系统的过程 逐渐减少或减少用药。促进停用靶向特定药物的干预措施 课程，如中枢神经系统药物，或特定人群，如那些现有的认知障碍，没有 在住院环境中得到了很好的学习。这一差距是一个关键的机会，有可能减少 易感患者中不适当的中枢神经系统药物及其衰弱副作用--与国家 老龄化研究所的优先事项是改善老年人的用药情况。Pavon博士的K23奖建议 开发并试行取消处方干预，该干预由行为理论模型提供信息 变化。目标1的结果将为该问题的流行病学提供信息，并确定目标人群 招聘。目标2将使用定性方法来检查医院取消处方的障碍和促进者。 结果将为最适合促进中枢神经系统药物停药的干预提供策略 一种可以容忍的、可行的方式。AIM 3将开发和试点测试一种基于医院的多组件除尘器 规定使用健康信息学进行内容交付的干预措施，以及提供商行为改变和 患者激活策略。这项工作将促进对1)哪些患者和中枢神经系统药物的理解 以取消处方干预为目标的类别，2)取消处方是否存在独特的障碍 医院环境，以及3)安全停药的最佳给药策略。在这段K23授权期内，Dr。 Pavon还将完成马尔可夫建模统计技术、干预方面的额外培训 发展、健康信息学和领导力。Pavon博士的导师团队将为 在衰老、药理学、医院医学和研究方法方面的专业知识。这份职业发展 该计划将使Pavon博士掌握在医院环境中进行干预开发研究的技能。 这项培训和由此产生的数据将使Pavon博士成为R01干预设计的有力候选人 为近1/2的老年人停用中枢神经系统药物提供便利，这些老年人将接触到 住院期间服用中枢神经系统药物。

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.