The Causes and Consequences of Risky Prescribing

项目概要-项目2 在过去的几十年里，处方药已经改变了病人的护理，带来了惊人的好处，但它们的 使用也带来了风险;这对老年人来说尤其如此。我们建议研究三个常见的- 处方但具有潜在风险的药物组（阿片类镇痛药、苯二氮卓类和非苯二氮卓类 镇静催眠药）。我们将探讨这些药物的使用如何随着时间的推移而变化，以及它们的使用如何单独改变。 或组合，与重要的健康结果相关，包括福尔斯、机动车事故、骨折和 药物过量事件。在近老年人、老年人和老年人中， 非常老的成年人使研究这些物质在老龄人口至关重要，我们的理解， 安全配置文件。但是，这些药物对于高质量，仁慈的疼痛管理，极端的 焦虑和空气饥饿，可以表征生命结束的经验，以及许多急性和慢性健康 条件;因此，使用不足可能与过度使用一样繁重。我们的建议有四个目标：目标1：描述 老年人接受危险药物的模式，包括阿片类镇痛药、苯二氮卓类、镇静催眠药。 目的2：测量老年人接受危险药物的相关结局。目的3：探讨临床医生，健康 系统和与潜在危险处方相关的外部因素。目标4：利用自然资源 实验，以确定危险处方模式的合理原因和 处方药使用对不良健康事件的影响。因为我们预期这些药物的异质效应 在不同的人群中，每个目标都将检查总体人群以及具有可行性的子人群， 由于生物学因素，我们将专门研究药物接收，结果和预测因素， 按年龄、性别、种族/民族、贫困、长期护理住所和发病率界定的群体，包括 痴呆和行为健康状况。该提案涉及NIA优先研究领域，包括 “50岁及以上成年人使用大麻和处方阿片类药物和苯二氮卓类药物的情况”，“健康 差异和少数民族老龄化问题，”“共病条件的相互作用，这些条件的治疗， 干预措施的有效性，以优化多个老年患者的获益和风险平衡， 条件”，以及在我们计划的亚组分析中，“与阿尔茨海默病相关的社会科学研究 以及相关的痴呆症。”

PROJECT SUMMARY – PROJECT 2 Prescription drugs have transformed patient care over the last several decades with stunning benefits, but their use has also conferred risks; this is especially true for the elderly. We propose to study three commonly- prescribed but potentially risky groups of drugs (opioid analgesics, benzodiazepines, and non-benzodiazepine sedative hypnotics). We will explore how use of these drugs has changed over time and how their use, alone or in combination, is related to important health outcomes including falls, motor vehicle accidents, fractures and overdose events. Heightened susceptibility to the adverse effects of powerful drugs among near old, old, and very old adults makes study of these substances in aging populations essential to our understanding of their safety profile. But, these same drugs are important to high-quality, merciful management of pain, extreme anxiety and air hunger that can characterize end of life experience as well as many acute and chronic health conditions; underuse thus may be as burdensome as overuse. Our proposal has four aims: Aim 1: To describe patterns of risky drug receipt by the elderly, including opioid analgesics, benzodiazepines, sedative hypnotics. Aim 2: To measure outcomes related to risky drug receipt by the elderly. Aim 3: To explore clinician, health system, and external factors associated with potentially hazardous prescribing. Aim 4: To leverage natural experiments to identify plausible causes of hazardous prescribing patterns and plausibly causal effects of prescription drug use on adverse health events. Because we anticipate heterogeneous effects of these drugs in distinct populations, each aim will examine the overall population as well as sub-populations with feasible diverse vulnerabilities due to biologic factors; we will specifically study drug receipt, outcomes and predictors in groups defined by age, sex, race/ethnicity, poverty, long-term care residence and morbidities, including dementia and behavioral health conditions. This proposal addresses NIA priority research areas including “aspects of marijuana and prescription opioid and benzodiazepine use in adults aged 50 and older,” “health disparities and minority aging issues,” “interactions of comorbid conditions, therapies for these conditions, and the efficacy of interventions to optimize the balance of benefits and risks for the older patient with multiple conditions,” and, in our planned subgroup analyses, “social science research related to Alzheimer’s disease and related dementias.”