Epidemiology and Risk of Antipsychotic Use in Hospitalized Elderly with Delirium

项目摘要/摘要 每年有200万老年人在医院接受抗精神病药物(APM)治疗，主要是治疗精神错乱。 尽管APM的危害已经有了很好的记录，而且在老年痴呆症患者中的使用量也有所下降，但 住院老年人中标签外APM暴露的范围和风险在很大程度上仍不清楚。的目标是 这项应用是为了确定APM及其替代品在住院期间的处方趋势和风险 老年人术后精神错乱。研究小组将分析来自2个国家住院数据的数据- 来自NIH资助的5个队列的基础和详细的临床数据，以产生证据表明 APMS及其替代品，可推广到现实世界的患者。中心假设是标签外的 在住院的老年人中，使用APM与不使用APM相比，不良事件的风险增加 尤其是较新的“非典型”APM可能比传统的“典型”APM危害更大。 CAL“APM短期使用。申请人的初步数据显示，尽管非典型的非典型非典型肺炎可能是 对住院老年外科患者的典型APM有害，使用非典型APM和某些精神药物 近年来，毒品的数量一直在上升。美国各地的APM处方率也有30多倍的差异 医院，这表明可能不适当的处方。住院APM缺乏安全性数据 老年人，以及几乎没有证据表明更安全的替代品似乎促成了这些趋势。其基本原理是 对于这一应用，来自痴呆症患者的可用安全性数据可能不适用于住院治疗 年长的外科患者以及APM和其他精神活性药物相对安全性的证据 常规护理患者不能仅从临床试验中产生。这项为期3年的提案有3个具体目标： 1)确定住院死亡率、住院出院、住院时间延长和再入院的风险 与大手术后精神障碍的老年患者不同的APM相关；2)确定发生脑瘫的风险。 与不同APM相关的医院非致命性不良事件；以及3)识别可能 通过检查纵向处方趋势，将其作为APM的治疗替代品。调查- TORS将应用创新的研究方法，利用现有的大型索赔数据集和队列数据 增强对常规护理人群的普适性，增加统计能力以解决患者的安全问题 亚组和个别药物，并减少偏见。通过对案例识别算法进行验证， 调查人员将改进住院药物安全研究中衡量住院不良事件的方式。 这项研究的影响是显著的，因为高质量的证据表明非专利药品的相对安全性 他们的替代品可以指导临床医生减少APM的过度使用，促进合理安全的APM 处方，从而提高了老年外科患者的安全性和临床护理。

PROJECT SUMMARY/ABSTRACT Each year 2 million older adults receive antipsychotic medications (APMs) in the hospital, mainly for delirium. Although the harms of APMs are well documented and their use has declined in older adults with dementia, the scope and risk of off-label APM exposure in hospitalized older adults remain largely unknown. The objective of this application is to determine the prescribing trends and risks of APMs and their alternatives in hospitalized older adults with postoperative delirium. The research team will analyze data from 2 national inpatient data- bases and detailed clinical data from 5 NIH-funded cohorts to generate evidence on the comparative safety of APMs and their alternatives that is generalizable to real-world patients. The central hypothesis is that off-label APM use is associated with increased risk of adverse events compared with no use in hospitalized older adults with postoperative delirium; in particular, newer “atypical” APMs may be more harmful than conventional “typi- cal” APM for short-term use. The applicant's preliminary data showed that, although atypical APMs may be as harmful as typical APM in hospitalized older surgical patients, use of atypical APMs and certain psychoactive drugs has been rising in recent years. The APM prescribing rates also vary more than 30 folds across the US hospitals, which suggests potentially inappropriate prescribing. Lack of safety data on APMs for hospitalized older adults, as well as little evidence on safer alternatives seems to contribute to these trends. The rationale for this application is that the available safety data from dementia patients may not generalize to hospitalized older surgical patients and that evidence on the comparative safety of APMs and other psychoactive drugs in routine care patients cannot be generated from clinical trials alone. This 3-year proposal has 3 specific aims: 1) determine the risk of in-hospital mortality, institutional discharge, prolonged length of stay, and readmission associated with different APMs in older patients with delirium after major surgery; 2) determine the risk of in- hospital non-fatal adverse events associated with different APMs; and 3) identify psychoactive drugs that may be prescribed as therapeutic alternatives to APMs by examining longitudinal prescribing trends. The investiga- tors will apply innovative research methodologies of leveraging existing large claims datasets and cohort data to enhance generalizability to routine care populations, increase statistical power to address safety for patient subgroups and individual drugs, and reduce bias. By conducting validation of case-identification algorithms, the investigators will improve how in-hospital adverse events are measured in inpatient drug safety research. The impact of this research is significant, because high-quality evidence on the comparative safety of APMs and their alternatives can guide clinicians to reduce excessive APM use and promote rational and safe APM prescribing, thereby improving safety and clinical care of older surgical patients.