Use of Psychotropic Medications Among Older Adults Receiving Hospice Care

参加临终关怀的医疗保险受益人人数持续增长，老年人占 接受临终关怀服务的病人比例最大。行为和心理症状， 不符合精神障碍的标准在临终护理的患者中是常见的（例如，感到悲伤， 焦虑，或激动），然而，对这些患者使用精神药物治疗的益处 患者不太清楚。此外，许多药物被认为是姑息治疗中必不可少的，如 苯二氮卓类药物和常规抗精神病药通常被认为不适合用于老年人。 成年人会产生各种相关的不良反应，这可能会使生命结束时的生活质量恶化。 目前，人们对精神药物如何在临终关怀中使用知之甚少， 很少有治疗指南来指导适当和安全的使用。尽管医疗保险受益人的数量 参加临终关怀和精神药物的使用程度建议由以前的研究，我们知道很少 与这种广泛的精神药物使用相关的因素以及特定患者是否更有可能 接受这样的待遇。这项混合方法研究将利用医疗保险临终关怀索赔和D部分数据， 提供医疗保险受益人中精神药物使用的全面国家估计数 接受临终关怀我们将建立在这个大规模的数据方法使用焦点小组与家庭 临终关怀病人的成员和提供者，将提供独特的见解，精神科的基本原理， 临终关怀中的药物使用，以及护理人员和临终关怀提供者如何权衡风险， 常用精神药物的好处。作为第一个全国性的精神药物使用估计， 老年医疗保险临终关怀受益人，这项研究将提供见解，告知潜在的治疗指南， 精神药物的使用，以尽量减少暴露于不良反应，同时提高生活质量结束时， 生活GEMSSTAR计划支持，项目，指导团队和教育计划将是无价的，因为 候选人的职业发展是一名独立调查员，专注于整合和改进 临终关怀中的精神病护理质量。

The number of Medicare beneficiaries enrolled in hospice has continued to grow, and older adults account for the largest proportion of patients receiving hospice services. Behavioral and psychological symptoms that do not meet criteria for a psychiatric disorder are common among patients in end of life care (e.g., feeling sad, anxious, or agitated), however the benefit of symptom-driven treatment with psychotropic medications for these patients is less clear. Additionally many medications considered essential in palliative medicine, such as benzodiazepines and conventional antipsychotics, are generally considered inappropriate for use in older adults given a variety of associated adverse effects, which can worsen quality of life at the end of life. Currently, little is known about how psychotropic medications are being used within end of life care and there are few treatment guidelines to guide appropriate and safe use. Despite the number of Medicare beneficiaries enrolled in hospice and the extent of psychotropic use suggested by previous studies, we know little about the factors associated with such widespread psychotropic use and whether particular patients are more likely to receive such treatment. This mixed-methods study will draw on Medicare hospice claims and Part D data to provide comprehensive national estimates of psychotropic medication use among Medicare beneficiaries receiving hospice care. We will build on this large-scale data approach using focus groups with family members and providers of hospice patients that will provide unique insights into the rationale of psychotropic medication use in end of life care, as well as how caregivers and hospice providers weigh the risks and benefits of commonly-used psychotropic medications. As the first national estimate of psychotropic use among older Medicare hospice beneficiaries, this study will provide insights to inform potential treatment guidelines for psychotropic medication use to minimize exposure to adverse effects while promoting quality of life at end of life. The GEMSSTAR program support, project, mentoring team, and educational plan will be invaluable as the candidate progresses towards a career as an independent investigator focused on integration and improving quality of psychiatric care within end of life care.