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Variations in nursing home residents' depression by level of cognitive impairment

疗养院居民抑郁程度随认知障碍程度的变化

基本信息

批准号：
9548551
负责人：
Christine Marie Ulbricht
金额：
$ 20.94万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2020-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9548551
关键词：
Address Admission activity Adult Affect Age Aggressive behavior Aging American Antidepressive Agents Behavioral Symptoms Big Data Big Data to Knowledge Caring Characteristics Clinical Clinical Trials Cognitive Comorbidity Complex Data Data Set Development Diabetes Mellitus Diagnosis Dimensions Drug Prescriptions Elderly Goals Health Heterogeneity Impaired cognition Impairment Intervention Knowledge Link Long-Term Care Measures Medical Medical center Medicare Part A Medicare claim Mental Depression Methods Modeling National Institute on Aging Nerve Degeneration Nursing Homes Outcome Pain Patients Personal Satisfaction Population Precision Medicine Initiative Process Reporting Research Research Support Role Severities Subgroup Suicide Testing United States National Institutes of Health Variant Work age group age related aging brain base care systems cognitive function cost depressive symptoms experience health service use healthy aging human old age (65+)improved individual patient individualized medicine interest longitudinal dataset meetings multiple chronic conditions novel nursing home length of stay person centered precision medicine prevent tool treatment effect treatment response

项目摘要

PROJECT SUMMARY/ABSTRACT Approximately 1.4 million older adults live in nursing homes. The majority of nursing home residents have moderate or severe cognitive impairment. Cognitive impairment can negatively impact a variety of health outcomes. The federal Precision Medicine initiative highlights the need to identify specific subgroups that respond to tailored interventions and ultimately provide clinicians with knowledge and tools necessary to select treatments that work best for the unique needs of an individual patient. Using a comprehensive longitudinal dataset, the proposed research will employ a novel analytic approach to evaluate the role of cognitive impairment on a selected common condition in nursing home residents -- depression. The heterogeneous symptoms of depression can indeed impair cognitive functioning. Depression treatment has been identified by the National Institute on Aging as a way to potentially prevent cognitive impairment and promote healthy aging. We propose using the national federally-mandated Minimum Data Set (MDS) 3.0 linked to Medicare Part A and D claims data to: 1) identify subgroups of depression among nursing home residents and evaluate if these subgroups differ by cognitive impairment status; 2) characterize how these subgroups change throughout the nursing home stay and estimate the extent to which these changes differ by level of cognitive impairment; and 3) estimate the extent to which antidepressant treatment effects vary across identified subgroups of depression and levels of cognitive impairment. Latent class and latent transition analyses with causal inference methods will be used. This proposal addresses the National Institute on Aging’s strategic research directions on how to improve the health and well-being of adults as they age by developing interventions for preventing or reducing the burden of age-related conditions (Goal C) and increasing knowledge of the aging brain and neurodegeneration (Goal D). This exploratory research will provide valuable information to inform precision medicine efforts and improve the processes of care to a population most in need.

项目摘要/摘要大约有140万老年人住在养老院。大多数养老院居民都有中度或严重的认知障碍。认知障碍会对多种健康产生负面影响结果。联邦精准医学倡议强调需要确定特定的子组，响应量身定制的干预措施，最终为临床医生提供必要的知识和工具最能满足患者独特需求的治疗方法。使用全面的纵向数据集，建议的研究将使用一种新的分析方法来评估认知的作用疗养院居民中一种选定的常见疾病--抑郁症的损害。异质的抑郁症的症状确实会损害认知功能。抑郁症的治疗已经被确定为国家老龄化研究所作为一种潜在的预防认知障碍和促进健康老龄化的方法。我们建议使用联邦规定的国家最低数据集(MDS)3.0与联邦医疗保险A部分和 D声称数据是为了：1)确定疗养院居民中的抑郁亚群，并评估这些亚群亚组因认知障碍状态而异；2)描述这些亚组在整个过程中如何变化入住养老院，并估计这些变化根据认知障碍程度的不同程度；以及 3)估计抗抑郁剂治疗效果在不同的抑郁症亚组中的差异程度以及认知障碍的程度。用因果推理方法进行潜在类和潜在转移分析将会被使用。这项提案涉及国家老龄研究所关于如何通过制定预防或减少衰老的干预措施，改善成年人的健康和福祉年龄相关疾病的负担(目标C)和对老化大脑和神经变性(目标D)。这项探索性研究将提供有价值的信息，以告知PRECIST 医疗努力和改善对最需要帮助的人口的护理过程。