Medication risks and challenges among people with dementia who live alone

独居痴呆症患者的用药风险和挑战

• 批准号: 10701791
• 负责人: Matthew Evan Growdon
• 金额: $ 16.15万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10701791
• 关键词: Adverse drug event; Advocate; Affect; Aging; Alzheimer' s disease related dementia; American; Anti-Cholinergics; Anticoagulants; Award; Classification; Clinical; Cognitive; Cohort Studies; Communities; Community Services; Data; Data Element; Dementia; Disease; Drug Prescriptions; Effectiveness; Elderly; Exposure to; Face; Future; Geriatrics; Goals; Health; Health system; High Prevalence; Hospitalization; Hypoglycemia; Hypoglycemic Agents; Impaired cognition; Insulin; Intervention; K-Series Research Career Programs; Knowledge; Link; Low income; Medicare; Medicare claim; Medication Management; Mission; National Institute on Aging; Neurology; Opioid Analgesics; Participant; Patient Care; Patients; Pattern; Persons; Pharmaceutical Preparations; Policies; Polypharmacy; Population; Prevalence; Proxy; Psychiatry; Public Health; Quality of Care; Quality of life; Reporting; Research; Research Personnel; Research Project Grants; Risk; Risk Factors; Safety; Seminal; Services; Social support; Specialist; Therapeutic Index; Vulnerable Populations; Work; career development; cohort; common treatment; contextual factors; design; drug misuse; experience; high risk; improved; innovation; medication safety; prescription opioid; primary care setting; programs; rural setting; shared decision making; social factors; social vulnerability; trend

PROJECT SUMMARY/ABSTRACT One-third of older adults with dementia live alone. A crucial challenge facing this vulnerable, growing, and understudied population is the safe and effective use of medications. Due to cognitive impairment, people with dementia (PWD) are more likely to misuse medications and face a threefold increased risk of medication- related hospital admissions compared to those without dementia. For older adults with dementia who live alone, the situation is even more dire. PWD living alone are more likely to lack support with medication management than those living with others. They are therefore potentially at higher risk of adverse drug events, particularly when exposed to certain high-risk medications. Despite recognition of the vulnerability of PWD who live alone, we lack reliable national data regarding medication use in this population. The objective of this study is to characterize high-risk medication use (defined as medications with adverse cognitive effects and medications with a low tolerance of misuse, including anticoagulants, hypoglycemics such as insulin, and opioid medications) and medication management supports and challenges among PWD who live alone. Using a nationally representative US cohort derived from merged National Health and Aging Trends Study (NHATS) data and Medicare claims, we will investigate two specific aims: (1) To determine the prevalence of and risk factors for high-risk medication use among PWD living alone and to compare this to PWD living with others and (2) To characterize medication management supports and challenges among PWD who live alone compared to those who live with others. We will determine medication use from Medicare Part D claims and will elucidate medication management supports and challenges from NHATS self and proxy reports. Significance & Innovation: Results from the proposed research project will directly inform clinical and policy interventions to support community-dwelling PWD, including a sizeable fraction who are living alone. This aligns with the National Institute on Aging's mission of promoting better quality of life for older Americans, including those with Alzheimer's Disease and Related Dementias, and improving the safe use of medications by older adults. This project is innovative because it will be the first to provide reliable national data regarding what high-risk medications are prescribed in this vulnerable group and to identify health system, patient/clinical, and social factors associated with these prescribing patterns. Describing medication management supports and challenges will identify populations in greatest need of supportive interventions. Future directions of this work include designing targeted interventions to improve the quality and safety of medication prescribing and provision of supportive services for community-dwelling PWD who live alone.

项目摘要/摘要 患有痴呆症的老年人中有三分之一独居。这一脆弱、不断增长和 研究不足的人群是安全有效地使用药物。由于认知障碍，患有认知障碍的人 痴呆症(PWD)更有可能滥用药物，并面临三倍的用药风险- 与非痴呆症患者的住院相关情况进行比较。适用于患有痴呆症的老年人 单枪匹马，形势更加严峻。独居的PWD更有可能缺乏药物的支持 管理比那些与他人生活在一起的人更重要。因此，他们可能面临更高的药物不良事件风险， 尤其是在接触某些高风险药物的情况下。尽管认识到世界卫生组织残障人士的脆弱性 单独生活，我们缺乏关于这一人群用药的可靠的国家数据。这项研究的目的是 是描述高风险药物使用的特征(定义为具有不良认知影响和 对滥用耐受性低的药物，包括抗凝血剂、降糖药，如胰岛素和 阿片类药物)和药物管理对独居的残疾患者的支持和挑战。vbl.使用 来自合并的国家健康和老龄化趋势研究(NHATS)的具有全国代表性的美国队列 数据和医疗保险索赔，我们将调查两个具体目标：(1)确定患病率和风险 独居PWD患者高危用药的影响因素及与其他人群的比较 以及(2)描述独居残疾患者对药物管理的支持和挑战 与那些与他人生活在一起的人相比。我们将根据Medicare Part D Claims和 将阐明NHATS自我报告和代理报告对药物管理的支持和挑战。 意义和创新：拟议研究项目的结果将直接为临床和政策提供信息 采取干预措施支持社区居住的残障人士，包括相当一部分独居的残疾人。这 与国家老龄研究所促进美国老年人更好生活质量的使命一致， 包括阿尔茨海默病和相关痴呆症患者，并提高药物使用的安全性 被年纪较大的人。该项目具有创新性，因为它将是第一个提供可靠的国家数据的项目 在这一弱势群体中开出了哪些高危药物，以确定卫生系统， 与这些处方模式相关的患者/临床和社会因素。描述用药情况 管理支持和挑战将确定最需要支持性干预的人群。 这项工作的未来方向包括设计有针对性的干预措施，以提高 为独居社区的残障人士开药和提供支助服务。