Perioperative mental health intervention for older adults undergoing cardiac surgery

老年人心脏手术围术期心理健康干预

• 批准号: 10616808
• 负责人: Michael Simon Avidan
• 金额: $ 26.36万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10616808
• 关键词: Address; Antidepressive Agents; Anxiety; Attention; Behavior Therapy; Behavioral; Benzodiazepines; Cardiac; Cardiac Surgery procedures; Cessation of life; Clinical Research; Clinical Trials Design; Communication; Community Practice; Coupled; Delirium; Depressed mood; Effectiveness; Effectiveness of Interventions; Elderly; Emotional; Enrollment; Event; Evidence based intervention; Family; Fright; Goals; Grant; Heart Diseases; Hospitals; Hybrids; Individual; Intensive Care; Intervention; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mission; Morbidity - disease rate; Motivation; Multicenter Trials; National Institute of Mental Health; Older Population; Operative Surgical Procedures; Outcome; Participant; Patient Preferences; Patient-Focused Outcomes; Patients; Perioperative; Pharmaceutical Preparations; Phase; Polypharmacy; Population; Postoperative Period; Preparation; Prevalence; Prevention; Procedures; Process; Protocols documentation; Provider; Psyche structure; Public Health; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Research Personnel; Risk; Risk Factors; Symptoms; Targeted Research; Testing; Time; United States; adverse outcome; anxiety symptoms; anxious; clinical practice; clinically significant; compare effectiveness; depressive symptoms; dosage; effective therapy; effectiveness outcome; effectiveness testing; experience; falls; group intervention; hospital readmission; human old age (65+); implementation outcomes; implementation/effectiveness; improved; innovation; interactive feedback; medical complication; mortality; mortality risk; multidisciplinary; older patient; pharmacologic; programs; protocol development; randomized, clinical trials; reduce symptoms; shared decision making; social; therapy development; time interval; treatment as usual; trial design

Abstract/Project Summary – PROJECT 3 Depression and anxiety are common but undertreated in older adults undergoing cardiac surgical procedures. Approximately 400,000 older adults undergo cardiac surgery annually in the United States, and between a quarter and a half of these individuals have symptoms of preoperative anxiety or depression. Each of these individuals are at greater risk for depression/anxiety than the general older population. The perioperative period is a particularly vulnerable time, as the patient is concurrently confronted with social, functional and physical changes that accompany a major surgery. Most older adults with heart disease and depression or anxiety do not receive appropriate mental health treatment, and if they do, it is typically limited to pharmacologic interventions, further exacerbating already rampant polypharmacy. In this proposal, we will optimize and test a pharmacological and behavioral intervention bundle for older patients undergoing cardiac surgery, with clinically significant depressive and anxiety symptoms. We will institute a perioperative mental healthcare intervention bundle including: (1) applying a proven behavioral intervention, behavioral activation (BA), with strategies based on patient preferences and needs; and (2) medication optimization and deprescribing (MOD), targeting to optimize dosages of anti-depressant medications, and stopping harmful or ineffective medications. Aim 1 (Adaptation): Informed by a collaborative planning approach, we will adapt, develop and implement an optimal perioperative mental health intervention bundle for older adults undergoing major invasive cardiac procedures. Through stakeholder input, we will develop and iteratively adapt a behavioral and medication optimization intervention bundle for implementation in this population. Following initial protocol development, through treatment development trials, we will iteratively optimize the intervention through interactive feedback from patients over the age of 65 undergoing major cardiac intervention, and other stakeholders, noting barriers and facilitators to program completion. Aim 2 (Testing): Using a hybrid Type 1 randomized controlled trial design, we will compare the effectiveness of the intervention bundle with usual care in reducing symptoms of depression and anxiety in older patients undergoing cardiac surgery. For this aim, 100 patients with symptoms of depression and anxiety will be randomly assigned to the pharmacological and behavioral intervention bundle or usual care. Pre-operative depression and anxiety are associated with a host of adverse outcomes after surgery, including medical complications, falls, delirium, and mortality. Thus, medication optimization and deprescribing, in an intervention bundle with behavioral activation treatment of depression and anxiety in older adults undergoing cardiac surgery, is expected to improve not only symptoms of depression and anxiety but also other important post-operative outcomes.

摘要/项目摘要-项目3 抑郁和焦虑在接受心脏外科手术的老年人中很常见，但治疗不足。 在美国，每年大约有40万老年人接受心脏手术， 其中四分之一和一半的人有术前焦虑或抑郁的症状。这一切成功都 与一般老年人相比，老年人患抑郁症/焦虑症的风险更大。围手术 期间是一个特别脆弱的时间，因为病人同时面临社会，功能和 伴随大手术的身体变化。大多数患有心脏病和抑郁症的老年人， 焦虑没有得到适当的心理健康治疗，如果他们这样做，它通常仅限于 药物干预，进一步加剧已经猖獗的多种药物。在本提案中，我们将 优化和测试接受心脏手术的老年患者的药理学和行为干预包 外科手术，具有临床显著的抑郁和焦虑症状。我们会在手术期间 健康护理干预包包括：（1）应用经证实的行为干预、行为激活 (BA)，根据患者的偏好和需求制定策略;以及（2）药物优化和 取消处方（MOD），以优化抗抑郁药物的剂量为目标，并停止有害或 无效的药物。目标1（适应）：通过协作规划方法，我们将适应， 制定并实施最佳的围手术期心理健康干预包，为老年人接受 主要的侵入性心脏手术。通过利益相关者的投入，我们将开发和迭代地适应一个 行为和药物优化干预捆绑包，用于在该人群中实施。以下 初步方案开发，通过治疗开发试验，我们将迭代优化干预措施 通过接受主要心脏介入治疗的65岁以上患者的互动反馈， 利益相关者，指出完成计划的障碍和促进因素。目标2（测试）：使用混合型1 随机对照试验设计，我们将比较干预束与常规护理的有效性 减少老年心脏手术患者的抑郁和焦虑症状。为此， 100名有抑郁和焦虑症状的患者将被随机分配到药物组， 行为干预捆绑或常规护理。术前抑郁和焦虑与宿主有关 手术后的不良结局，包括内科并发症、福尔斯、谵妄和死亡率。因此，在本发明中， 药物优化和取消处方，在干预捆绑与行为激活治疗， 抑郁症和焦虑症的老年人接受心脏手术，预计不仅改善症状， 以及其他重要的术后结果。