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

这项研究提出了一项纵向研究，以评估阿片类药物处方做法对结果的影响 阿尔茨海默病及相关痴呆症患者(ADRD)。这项研究是对优先事项的反应 由应对阿尔茨海默病的国家计划支持：目标2提高护理质量和效率 以解决因慢性疾病并存而引起的ADRD患者的护理需求。慢性疼痛在以下方面很常见 ADRD，90%的受影响患者依赖阿片类药物治疗来缓解疼痛 症状。在过去十年中，ADRD处方类阿片类药物的使用翻了一番；在吸毒者中，超过一半 长期或与其他中枢神经系统(CNS)抑郁药同时使用阿片类药物， 与目前的疼痛指南建议的相反。然而，这些指导方针主要改编了证据 认知健康的年轻人或老年人，以及他们是否适合ADRD患者 目前仍不清楚。为了向ADRD的疼痛管理提供治疗决策，迫切需要 现有阿片类药物处方做法临床效果的证据，考虑结果与 治疗目标。对于患有慢性疼痛的老年人来说，迫切需要了解阿片类药物是否 改善或恶化认知，以帮助澄清当前文献中不确定的发现。来填补这些研究的空白 差距，这项拟议的研究将利用具有全国代表性的纵向调查和评估数据 与Medicare声称的研究阿片类药物处方做法对居住在美国的ADRD患者结局有关 社区和养老院。具体地说，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果。我们还将评估 阿片类药物与中枢神经系统药物同时使用与患者预后的关系 ADRD接受慢性阿片类药物治疗。此外，我们将评估阿片类药物使用和 中度或重度疼痛的非痴呆老年人认知功能的变化。我们会 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，包括与跌倒有关的伤害、住院和阿片类药物使用障碍或过量。我们的研究将 就常见阿片类药物处方做法对健康结局的影响提供经验证据 并阐明阿片类药物对患有慢性疼痛的老年人认知的作用。因为 ADRD人群很少包括在试验中，我们的数据将有很大潜力进一步了解 阿片类药物治疗的利弊，并告知患者最佳使用和安全的阿片类药物处方 阿德勒。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。

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.