Bladder Antimuscarinics in Dementia: A Model of Decisions About Potentially Inappropriate Medicines

痴呆症中的膀胱抗毒蕈碱药：关于潜在不适当药物的决策模型

• 批准号: 9926791
• 负责人: Ariel Green
• 金额: $ 19.87万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926791
• 关键词: Address; Admission activity; Adoption; Adverse effects; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Anti-Cholinergics; Antipsychotic Agents; Area; Award; Benzodiazepines; Bladder; Caregivers; Cessation of life; Cognitive; Conflict (Psychology); Constipation; Data; Decision Aid; Decision Making; Delirium; Dementia; Dementia caregivers; Development; Discourse analysis; Disease; Elderly; Epidemiology; Evaluation; Family; Fostering; Frequencies; Funding; Future; Geriatrics; Gerontology; Goals; Health; Health Care Costs; Hospitalization; Incontinence; Individual; Intervention Studies; Interview; Judgment; K-Series Research Career Programs; Knowledge; Lead; Learning; Link; Medicare claim; Medicine; Mentors; Modeling; Nature; Nursing Homes; Outcome; Patients; Persons; Pharmaceutical Preparations; Prevalence; Publications; Qualitative Methods; Quality of life; Randomized Controlled Trials; Research; Research Personnel; Resources; Retrospective cohort study; Safety; Source; Testing; Training; Universities; Urinary Incontinence; career; career development; caregiver strain; cost; experience; falls; improved; informal learning; medical schools; medication safety; patient oriented; preference; professor; randomized trial; shared decision making; side effect; skills; systematic review; tool; trend

PROJECT SUMMARY Dr. Ariel Green is an Assistant Professor in the Department of Medicine, Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine. She seeks a K23 mentored career development award to obtain critical knowledge, skills and research experience to accelerate her development into a leader in patient-oriented geriatrics research. The training proposal details a four-year plan of formal and informal instruction in (1) epidemiology, particularly analytic skills using longitudinal, nationally-representative data linked to Medicare claims; (2) qualitative methods; (3) decision aid development and evaluation; and (4) interventional research in persons with Alzheimer's disease and related dementias. Short-term career goals include completing coursework in the above-mentioned areas, disseminating high-quality mentored research through publications and presentations, engaging in career development activities, and applying for independent R01 funding beginning in the third year of the award period. Long-term career goals are to be an independent geriatrics investigator who is a leader in shared decision making and medication safety in vulnerable older adults. Informing patients and families about potential outcomes and involving them in decision making could lead to a reduction in the use of potentially inappropriate medicines in patients with Alzheimer's disease and related dementias. The use of bladder antimuscarinics for treatment of urinary incontinence (UI) in older adults with dementia is an ideal model to learn how to improve decision making and develop an approach that could be applied to other potentially inappropriate medicines in people with dementia. The broad objective of this proposal is to address deficiencies in decision-making relating to antimuscarinic therapy in patients with dementia and UI. This will be accomplished through the following specific aims: (1) Among older adults (>65) with dementia and UI, to determine associations between antimuscarinic therapy and subsequent hospitalization, admission to NHs and death. (2a) To understand how patients, caregivers and clinicians communicate about antimuscarinic therapy in patients with dementia and UI. (2b) To determine how barriers to informed decision making about the use of antimuscarinic drugs in patients with dementia can be addressed. (3) To pilot an antimuscarinic decision aid for patients with dementia and UI and their caregivers. Completion of these aims will lay the groundwork for a future randomized trial to test an antimuscarinic decision aid for patients with dementia and UI and their caregivers.

项目摘要 Ariel绿色博士是老年医学部医学系的助理教授 和约翰霍普金斯大学医学院的老年学。她寻求K23指导的职业生涯 发展奖，以获得关键知识，技能和研究经验，以加速她的发展 成为以病人为导向的老年医学研究的领导者培训提案详细说明了一项正式和 在（1）流行病学，特别是分析技能，使用纵向，国家代表性 与医疗保险索赔相关的数据;（2）定性方法;（3）决策辅助开发和评估;以及（4） 对阿尔茨海默病和相关痴呆患者进行干预研究。短期职业目标 包括完成上述领域的课程，传播高质量的指导研究， 通过出版物和演讲，参与职业发展活动，并申请 独立R 01资助从奖励期的第三年开始。长期的职业目标是成为一个 独立的老年医学研究者，在共同决策和药物安全方面处于领先地位， 脆弱的老年人。 告知患者和家属潜在的结果，并让他们参与决策， 减少阿尔茨海默病患者使用可能不适当的药物， 相关的痴呆症膀胱抗毒蕈碱药治疗老年人尿失禁 是一个理想的模型，学习如何改善决策，并开发一种方法， 用于痴呆症患者的其他可能不合适的药物。其主要目标是 建议是解决与患者的抗毒蕈碱治疗有关的决策缺陷， 痴呆和UI。这将通过以下具体目标来实现：（1）老年人（>65岁） 痴呆和UI，以确定抗毒蕈碱治疗和随后的 住院、入住NHS和死亡。(2a)了解患者、护理人员和临床医生 交流痴呆和UI患者的抗毒蕈碱治疗。(2b)要确定如何设置障碍， 可以解决关于在痴呆患者中使用抗毒蕈碱药物的知情决策。 (3)为痴呆和UI患者及其护理人员试点抗毒蕈碱决策辅助。完成 这些目标将为未来的随机试验奠定基础，以测试抗毒蕈碱的决策援助， 痴呆和UI患者及其护理人员。

项目成果

How Can We Optimize Care and Outcomes for Patients with Mild Cognitive Impairment and Acute Myocardial Infarction?

我们如何优化轻度认知障碍和急性心肌梗死患者的护理和结果？

• DOI: 10.1007/s11606-019-05484-8
• 发表时间: 2020
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Green,ArielR

Perspectives on Deprescribing Communication in Primary Care.

关于在初级保健中取消沟通的观点。

• DOI: 10.1007/s11606-020-06377-x
• 发表时间: 2021
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Green,ArielR;Boyd,CynthiaM;Gleason,KathyS;Wright,Leslie;Kraus,CourtneyR;Bedoy,Ruth;Sanchez,Bianca;Norton,Jonathan;Sheehan,OrlaC;Wolff,JenniferL;Reeve,Emily;Maciejewski,MatthewL;Weffald,LindaA;Bayliss,ElizabethA
• 通讯作者: Bayliss,ElizabethA