Prescription Opioid Use Trajectories and Risk Factors Associated with Opioid-Related Hospitalizations in Older Adults

AHRQ最近关于关注卫生服务研究以解决阿片类药物危机的通知[NOT-HS-18- 015]委员会认识到，老年人中与类阿片有关的住院人数惊人地不成比例地增加。 尽管为打击全国阿片类药物流行病做出了大量努力，但由于阿片类药物而住院的人数仍然很少。 老年人中的依赖、滥用或中毒现象呈非理性增长。准确识别 对老年高危人群实施有效的预防措施，重要的是了解病因 该报告还强调了与类阿片有关的住院治疗，特别强调了老年人特有的风险因素。本研究将评估 老年高危处方阿片类药物使用模式、诱发和预后因素及其与 阿片类药物相关的住院治疗了解从处方阿片类药物开始使用到 阿片类药物相关的住院治疗结果，目标人群是启动处方的医疗保险受益人 阿片类药物在老年（65岁以上）包括在全国代表性样本的医疗保险受益人， 2001-20017.我们的目的1是检查处方阿片类药物使用的轨迹及其与阿片类药物相关性的关系。 在阿片类药物初治的老年人中开始治疗后的住院率。将评估处方阿片类药物的使用情况 通过四项措施：1）吗啡等效日剂量，2）伴随阿片类药物使用，3）慢性阿片类药物使用，以及4） 与其他精神药物同时使用（例如，苯并二氮杂卓）。我们的目标2是检查在多大程度上， 老年人特异性易感因素和预后因素与阿片类药物相关住院风险相关 在Medicare老年人中开始阿片类药物治疗后的结果。我们将研究独特的风险因素， 结果的发展，包括虚弱指数，慢性病和多种药物的数量。 在任何人群中发表的模型中，我们都是创新的，我们还将评估新出现的预后因素- 事件感染，认知障碍和伤害，反映了潜在的阿片类药物滥用和过量， 到住院治疗我们的研究将提供关于处方轨迹的第一手全国代表性数据 阿片类药物使用、易感特征和与阿片类药物相关的预后风险因素 老年阿片类药物启动者的住院治疗。确定的老年人特有的风险因素将为 未来的R 01旨在开发，实施和评估临床中的动态老年人特定风险评分 实践这一系列研究的结果将有助于临床医生识别和管理处于风险中的老年患者 阿片类药物相关不良事件，改善老年人群中的阿片类药物处方和安全性。

AHRQ's recent notice regarding Interest in Health Services Research to Address the Opioid Crisis [NOT-HS-18- 015] recognized the alarming disproportionate increase of opioid-related hospitalizations among older adults. Despite an abundance of efforts to combat the national opioid epidemic, hospitalizations due to opioid dependence, abuse or poisoning among older adults have grown disproportionally. To accurately identify the high-risk elderly groups and implement effective preventive measures, it is important to understand the etiology of opioid-related hospitalizations, with a special emphasis on elderly-specific risk factors. This study will assess elderly high-risk prescription opioid use patterns, predisposing and prognostic factors and their associations with opioid-related hospitalizations. To understand the progress from prescription opioid initiation to the development of opioid-related hospitalization outcome, the target population is Medicare beneficiaries who initiate prescription opioids at an older age (aged 65+) included in a nationally representative sample of Medicare beneficiaries from 2001-20017. Our Aim 1 is to examine trajectories of prescription opioid use and their association with opioid-related hospitalizations after initiation among opioid-naïve Medicare older adults. Prescription opioid use will be assessed by four measures: 1) morphine-equivalent daily dose, 2) concomitant opioid use, 3) chronic opioid use, and 4) concurrent use with other psychotropic drugs (e.g., benzodiazepines). Our Aim 2 is to examine the extent to which elderly-specific predisposing and prognostic factors are associated with risk for opioid-related hospitalization outcome after opioid initiation among Medicare older adults. We will examine unique risk factors for the development of the outcome, including a frailty index, number of chronic conditions and polypharmacy. Innovative among published models in any population, we will also evaluate emerging prognostic factors— incident infections, cognitive impairment, and injuries, reflecting potential opioid misuse and overdose that lead to hospitalizations. Our study will provide first-hand nationally representative data on trajectories of prescription opioid use, predisposing characteristics and prognostic risk factors associated with opioid-related hospitalizations in elderly opioid initiators. Identified elderly-specific risk factors will provide the foundation for a future R01 aimed at developing, implementing and evaluating a dynamic elderly-specific risk score in clinical practice. The results from this line of research will assist clinicians to identify and manage elderly patients at risk for opioid-related adverse events, improving opioid prescribing and safety in geriatric populations.