Unnecessary and Harmful Medication Use in Older Adults with Dementia

RP3项目总结 居住在社区的痴呆症(PWD)患者通常有多种共病疾病， 导致了广泛的药物使用。虽然药物治疗可以带来许多好处，但它们也可能导致 造成很大伤害。通常给老年人开的药物会损害认知，增加跌倒的风险， 并造成其他严重后果，往往没有可辨别的目的，并且经常与 剩余预期寿命和护理目标。这样的问题可能特别常见，对 鉴于这一人群对药物不良反应的易感性增加，沟通药物- 相关症状，并往往限制预期寿命。减少不必要或不必要药物的使用 可能造成的伤害大于好处，因此可以在改善残疾患者的生活质量方面发挥关键作用。然而， 实现这一目标的努力因知识方面的根本差距而受到影响。虽然之前的研究已经 记录了在社区居住的PWD中经常使用选定的不适当药物，更少的是 知道使用其他类型的不必要和有害的药物，如不必要的攻击性 疾病管理、重复疗法、无明确适应症的药物和药物 在生命接近尾声时不合适，而且对哪些风险因素可能会导致使用有问题的药物知之甚少 治疗。此外，在PWD中减少问题药物使用的努力可能会更成功 如果他们与患者和护理人员对用药的态度和偏好保持一致，那么还有很多事情要做 对这个话题一无所知。我们寻求通过一系列相互关联的具体目标来解决这些知识差距 利用高价值的国家数据来源，包括健康和退休研究(HRS)， 国家健康和老龄化趋势研究(NHATS)和联邦医疗保险A、B和D部分，使用链接的HRS和 联邦医疗保险数据，我们将评估社区中广泛的不必要和有害的药物使用- 居住PWD，并评估哪些风险因素和临床情况可能导致特别高的使用率 不必要和有害的药物。此外，我们还将利用中提供的独特数据元素 NHATS将探讨PWD及其照顾者对药物和减少机会的态度 药物使用。我们的目标是(1)描述不必要和有害的频率和类型 在社区居住的PWD中的药物使用，并将其与无PPD的人的使用模式进行比较 (2)评估社区中使用不必要和有害药物的危险因素- 居住的PWD，特别关注住院的作用，并确定这些危险因素 与非痴呆症患者不同；以及(3)使用来自NHATS的有效调查问题，以 描述居住在社区的PWD及其照顾者对他们的药物和他们的 停止服药的意愿。从这项研究中获得的信息将为干预措施提供信息，以减少 在社区居住的残障人士中，大量弱势群体的用药负担和危害。

RP3 PROJECT SUMMARY People with dementia (PWD) who live in the community often have multiple comorbid medical conditions, resulting in extensive medication use. While medications can yield many benefits, they can also result in substantial harms. Medications commonly prescribed to older adults can impair cognition, increase fall risk, and cause other serious outcomes, often serve no discernible purpose, and are frequently inconsistent with remaining life expectancy and goals of care. Such problems may be particularly common and damaging for PWD given this population’s enhanced susceptibility to adverse drug effects, difficulty communicating drug- related symptoms, and often limited life expectancy. Reducing use of medications that are unnecessary or likely to cause more harm than good can thus play a critical role in improving quality of life for PWD. Yet, efforts to achieve this are compromised by fundamental gaps in knowledge. While prior studies have documented frequent use of selected inappropriate medications in community-dwelling PWD, much less is known about use of other types of unnecessary and harmful medications such as unnecessarily aggressive disease management, duplicative therapies, medications with no clear indication, and medications inappropriate near the end of life, and little is known about which risk factors may drive use of problematic therapies. In addition, efforts to reduce use of problematic medications in PWD are likely to be more successful if they align with patient and caregiver attitudes and preferences toward medication use, yet much remains unknown about this topic. We seek to resolve these knowledge gaps through a series of linked specific aims that take advantage of high-value national data sources, including the Health and Retirement Study (HRS), National Health and Aging Trends Study (NHATS), and Medicare Parts A, B, and D. Using linked HRS and Medicare data, we will evaluate a broad range of unnecessary and harmful medication use in community- dwelling PWD, and assess which risk factors and clinical circumstances may lead to especially high use of unnecessary and harmful medications. In addition, we will capitalize on unique data elements present in NHATS to explore the attitudes of PWD and their caregivers toward medications and opportunities to reduce medication use. Our aims are (1) To characterize the frequency and types of unnecessary and harmful medication use in community-dwelling PWD, and to compare this to usage patterns in people without dementia; (2) To evaluate risk factors for use of unnecessary and harmful medication use among community- dwelling PWD, with a special focus on the role of hospitalization, and to determine whether these risk factors are different than in people without dementia; and (3) Using validated survey questions from NHATS, to characterize the attitudes of community-dwelling PWD and their caregivers toward their medications and their willingness to stop medications. Information gained from this study will inform interventions to reduce medication burdens and harms among the large and vulnerable population of community-dwelling PWD.