Longitudinal Impact of CNS Polypharmacy on Geriatric Syndromes

描述（由申请人提供）：由于不同类别的药物具有相似的药理学副作用，因此在老年人中使用多种药物或多药治疗是值得关注的。中枢神经系统多药是这种现象的一个常见和重要的例子。中枢神经系统多种药物可能有助于老年综合征的发展。老年综合征，如认知障碍，尿失禁和流动性/不稳定的问题也是常见的，病态和昂贵的老年人。随着药物使用增加的趋势，需要关于CNS多药治疗对老年人老年综合征影响的信息。长期目标是通过确定暴露时间的动态影响和CNS多药治疗对老年综合征的变化来增强老年人的健康，以便设计干预措施，改善健康结果并降低医疗保健成本。采用纵向设计，直接目标是确定随着时间的推移，中枢神经系统多药治疗对老年综合征的影响。CNS多药治疗将被定义为：1）使用来自六种药物类别中的任何一种的2种或更多种药物（即，苯二氮卓类、其他抗焦虑药/催眠药、阿片类镇痛药、抗抑郁药、抗精神病药和抗癫痫药）和2）这些多种CNS药物的组合标准化日剂量。我们将确定移动性/不稳定性性能（即，EPESE下肢成套测试、400米步行、平衡、自我报告的福尔斯）、认知功能（即，3 MS）和自我报告的尿失禁。待检验的具体假设是，与未受影响的老年人相比，在控制重要协变量（例如合并症）后，患有普遍、偶发和增加的CNS多药治疗的老年参与者将具有更大的活动性/不稳定性下降、认知能力下降增加和尿失禁的可能性增加。目前的建议可能具有很高的成本效益，并有望产生有效和可推广到老年人的结果。

DESCRIPTION (provided by applicant): Multiple drug use or polypharmacy due to medications from different classes that share similar pharmacological side effects is of concern in older adults. CNS polypharmacy is a common and important example of this phenomenon. CNS polypharmacy may contribute to the development of geriatric syndromes. Geriatric syndromes such as cognitive impairment, urinary incontinence and mobility/instability problems are also common, morbid and costly for older adults. With the trend towards increased use of medications, information is needed regarding the impact of CNS polypharmacy on geriatric syndromes in older adults. The long term objective is to enhance the health of the elderly by determining the dynamic effects over time of exposure and changes in CNS polypharmacy on geriatric syndromes, so that interventions can be designed, health outcomes improved and health care costs reduced. Using a longitudinal design, the immediate objective is to determine the impact over time of CNS polypharmacy on geriatric syndromes. CNS poly- pharmacy will be defined as: 1) the use of 2 or more medications from any of six medication classes (i.e., benzodiazepines, other anxiolytics/ hypnotics, opioid analgesics, antidepressants, antipsychotics and anti- epileptics) and 2) combined standardized daily dosage of these multiple CNS medications. We will determine mobility/instability performance (i.e., EPESE lower extremity battery, 400 meter walk, balance, self-reported falls), cognitive function (i.e., 3MS), and self-reported urinary incontinence. The specific hypotheses to be tested are that, compared with non affected elders, elderly participants with prevalent, incident and increasing CNS polypharmacy will have greater mobility/instability decline, increased cognitive decline, and increased likelihood of urinary incontinence after controlling for important covariates (e.g. comorbidities).This study capitalizes on data from the NIA-funded longitudinal Health ABC study. The current proposal is likely to be highly cost-effective and can be expected to yield results that are valid and generalizable to older adults.