Opioid Prescribing Practices and Health Outcomes among Patients with Alzheimer's Disease and Related Dementia

阿尔茨海默病和相关痴呆症患者的阿片类药物处方实践和健康结果

• 批准号: 10444395
• 负责人: Yu-Jung Wei
• 金额: $ 54.08万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444395
• 关键词: Address; Affect; Alzheimer' s Disease; Alzheimer' s disease related dementia; Anticonvulsants; Antidepressive Agents; Caring; Central Nervous System Agents; Central Nervous System Depressants; Chronic; Clinical; Clinical Trials; Cognition; Communities; Community Surveys; Complex; Cytochrome P450; Data; Data Set; Dementia; Diagnosis; Dose; Drug Kinetics; Elderly; Enzymes; Goals; Guidelines; Health; Hospitalization; Impaired cognition; Knowledge; Link; Literature; Longitudinal Studies; Longitudinal Surveys; Medicare; Medicare claim; Medication Systems; Memory; Mental Depression; Mental Health; Metabolic Pathway; Metabolism; Neuraxis; Nursing Assessment; Nursing Homes; Opioid; Outcome; Outcome Measure; Overdose; Pain; Pain intensity; Pain management; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacology; Pharmacotherapy; Physical Function; Population; Population Study; Probability; Property; Quality of Care; Recommendation; Reporting; Research; Retirement; Role; Safety; Sampling; Statistical Data Interpretation; Surveys; Time; Vulnerable Populations; Work; base; chronic pain; chronic pain management; clinical effect; clinical pain; cognitive function; cognitive testing; cohort; comorbidity; dementia risk; fall injury; falls; follow-up; high risk; improved; inhibitor; longitudinal dataset; neuropsychiatric symptom; non-cancer chronic pain; non-demented; opioid therapy; opioid use; opioid use disorder; pain symptom; physical conditioning; prescription opioid; primary outcome; safety outcomes; secondary outcome

This study proposes a longitudinal study to assess the effects of opioid prescribing practices on outcomes of patients with Alzheimer’s disease and related dementia (ADRD). The research is responsive to priorities espoused by the National Plans to Address Alzheimer’s disease: Goal 2 Enhance Care Quality and Efficiency to address care needs of ADRD patients due to co-occurring chronic conditions. Chronic pain is common in ADRD, with 90% of affected patients relying on pharmacotherapy, such as opioids, to relieve painful symptoms. Use of prescription opioids in ADRD has doubled over the last decade; among users, over half used opioids chronically or concurrently with other central-nervous-system (CNS) depressant medications, contrary to what current pain guidelines suggest. These guidelines, however, adapt evidence primarily from younger populations or older adults with healthy cognition and whether they are suitable for ADRD patients remains unclear. To inform treatment decisions for pain management in ADRD, there is an urgent need for evidence on the clinical effects of existing opioid prescribing practices, considering outcomes aligned with treatment goals. For older adults who suffer from chronic pain, there is a strong need to understand if opioids improve or worsen cognition to help clarify inconclusive findings in the current literature. To fill these research gaps, this proposed study will leverage nationally representative longitudinal survey and assessment data that are linked to Medicare claims to study opioid prescribing practices on outcomes of ADRD patients residing in communities and nursing homes. Specifically, we will examine the associations between the continuation of chronic opioid therapy with outcomes in patients with ADRD and chronic non-cancer pain. We will also evaluate the extent to which concurrent use of opioids with CNS drugs is associated with outcomes in patients with ADRD receiving chronic opioid therapy. Furthermore, we will assess associations between opioid use and changes in cognitive function among non-demented older adults who had moderate or severe pain. We will consider a range of clinical outcomes, including pain intensity, physical and mental health, and safety outcomes, including fall-related injuries, hospitalizations, and opioid use disorder or overdose. Our study will provide empirical evidence on the effects of common opioid prescribing practices on health outcomes pertinent to patients with ADRD and elucidate the role of opioids on cognition in older adults with chronic pain. Because ADRD populations are rarely included in trials, our data will have great potential to further knowledge of the benefits and harms of opioid treatment and inform optimal use and safe opioid prescribing in patients with ADRD. The long-term goal of this line of research is to improve management of chronic pain in older adults, particularly those with cognitive impairment.

本研究提出了一项纵向研究，以评估阿片类药物处方实践对 阿尔茨海默病和相关痴呆（ADRD）患者。这项研究是响应优先事项 国家应对阿尔茨海默病计划所支持的：目标2：提高护理质量和效率 以解决ADRD患者因合并慢性疾病而产生的护理需求。慢性疼痛是常见的， ADRD，90%的受影响患者依赖药物治疗，如阿片类药物，以缓解疼痛 症状在过去十年中，ADRD中处方阿片类药物的使用增加了一倍;在使用者中，超过一半的人 长期使用阿片类药物或与其他中枢神经系统（CNS）药物同时使用， 与目前的疼痛指南所建议的相反。然而，这些指南主要采用来自 年轻人群或认知健康的老年人，以及是否适合ADRD患者 仍不清楚为了告知ADRD疼痛管理的治疗决策，迫切需要 现有阿片类药物处方实践临床效果的证据，考虑到与 治疗目标。对于患有慢性疼痛的老年人来说，强烈需要了解阿片类药物是否 改善或恶化认知，以帮助澄清目前文献中的不确定结果。为了填补这些研究 由于存在差距，这项拟议的研究将利用具有国家代表性的纵向调查和评估数据， 与医疗保险索赔有关，以研究阿片类药物处方实践对居住在 社区和养老院。具体来说，我们将研究持续的 慢性阿片类药物治疗与ADRD和慢性非癌症疼痛患者的结局。我们还将评估 阿片类药物与CNS药物同时使用与以下患者结局相关的程度 接受慢性阿片类药物治疗的ADRD。此外，我们将评估阿片类药物使用与 有中度或重度疼痛的非痴呆老年人认知功能的变化。我们将 考虑一系列临床结果，包括疼痛强度、身心健康和安全性 结果，包括跌倒相关的损伤，住院治疗和阿片类药物使用障碍或过量。我们的研究将 提供关于常见阿片类药物处方做法对健康结果影响的经验证据 ADRD患者，并阐明阿片类药物对慢性疼痛老年人认知的作用。因为 ADRD人群很少被纳入试验，我们的数据将有很大的潜力，以进一步了解 阿片类药物治疗的益处和危害，并告知患者的最佳使用和安全阿片类药物处方 ADRD。这项研究的长期目标是改善老年人慢性疼痛的管理， 尤其是那些有认知障碍的人。