Unnecessary and Harmful Medication Use in Older Adults with Dementia

RP 3项目总结 生活在社区中的痴呆症（PWD）患者通常患有多种共病疾病， 导致大量的药物使用。虽然药物可以产生许多好处，但它们也可能导致 实质性的伤害。老年人常用的药物会损害认知能力，增加跌倒的风险， 并导致其他严重后果，往往没有明显的目的，并经常不符合 剩余寿命和护理目标。这些问题可能特别常见，对 考虑到这一人群对药物不良反应的敏感性增强，难以与药物- 相关的症状，而且往往寿命有限。减少使用不必要的药物，或 因此，可能造成弊大于利的疾病在改善残疾人生活质量方面发挥着关键作用。然而， 实现这一目标的努力因知识方面的根本差距而受到损害。虽然先前的研究 有记录表明，社区居住的PWD患者经常使用选定的不适当药物， 已知使用其他类型的不必要和有害的药物，如不必要的侵略性 疾病管理、重复治疗、无明确适应症的药物和药物 不适当的接近生命的尽头，很少有人知道哪些风险因素可能会导致使用有问题的 治疗此外，减少PWD患者使用有问题药物的努力可能会更成功 如果它们与患者和护理人员对药物使用的态度和偏好一致， 对这个话题一无所知。我们寻求通过一系列相互关联的具体目标来解决这些知识差距 利用高价值的国家数据源，包括健康和退休研究（HRS）， 国家健康和老龄化趋势研究（NHATS）和医疗保险A、B和D部分。使用链接的HRS和 医疗保险数据，我们将评估社区中广泛的不必要和有害的药物使用- 居住残疾人，并评估哪些风险因素和临床情况可能导致特别高的使用 不必要的和有害的药物。此外，我们将利用中存在的独特数据元素 NHATS旨在探索PWD及其护理人员对药物的态度以及减少 药物使用。我们的目标是（1）描述不必要和有害的频率和类型 社区居住的PWD患者的药物使用情况，并将其与没有 （2）评估社区中使用不必要和有害药物的风险因素- 居住PWD，特别关注住院的作用，并确定这些危险因素是否 与没有痴呆症的人不同;（3）使用NHATS的有效调查问题， 描述社区居住的PWD及其护理人员对他们的药物及其治疗的态度。 愿意停止药物治疗。从这项研究中获得的信息将为干预措施提供信息， 在社区居住的残疾人的大量和弱势群体中的药物负担和危害。

RP3 PROJECT SUMMARY People with dementia (PWD) who live in the community often have multiple comorbid medical conditions, resulting in extensive medication use. While medications can yield many benefits, they can also result in substantial harms. Medications commonly prescribed to older adults can impair cognition, increase fall risk, and cause other serious outcomes, often serve no discernible purpose, and are frequently inconsistent with remaining life expectancy and goals of care. Such problems may be particularly common and damaging for PWD given this population’s enhanced susceptibility to adverse drug effects, difficulty communicating drug- related symptoms, and often limited life expectancy. Reducing use of medications that are unnecessary or likely to cause more harm than good can thus play a critical role in improving quality of life for PWD. Yet, efforts to achieve this are compromised by fundamental gaps in knowledge. While prior studies have documented frequent use of selected inappropriate medications in community-dwelling PWD, much less is known about use of other types of unnecessary and harmful medications such as unnecessarily aggressive disease management, duplicative therapies, medications with no clear indication, and medications inappropriate near the end of life, and little is known about which risk factors may drive use of problematic therapies. In addition, efforts to reduce use of problematic medications in PWD are likely to be more successful if they align with patient and caregiver attitudes and preferences toward medication use, yet much remains unknown about this topic. We seek to resolve these knowledge gaps through a series of linked specific aims that take advantage of high-value national data sources, including the Health and Retirement Study (HRS), National Health and Aging Trends Study (NHATS), and Medicare Parts A, B, and D. Using linked HRS and Medicare data, we will evaluate a broad range of unnecessary and harmful medication use in community- dwelling PWD, and assess which risk factors and clinical circumstances may lead to especially high use of unnecessary and harmful medications. In addition, we will capitalize on unique data elements present in NHATS to explore the attitudes of PWD and their caregivers toward medications and opportunities to reduce medication use. Our aims are (1) To characterize the frequency and types of unnecessary and harmful medication use in community-dwelling PWD, and to compare this to usage patterns in people without dementia; (2) To evaluate risk factors for use of unnecessary and harmful medication use among community- dwelling PWD, with a special focus on the role of hospitalization, and to determine whether these risk factors are different than in people without dementia; and (3) Using validated survey questions from NHATS, to characterize the attitudes of community-dwelling PWD and their caregivers toward their medications and their willingness to stop medications. Information gained from this study will inform interventions to reduce medication burdens and harms among the large and vulnerable population of community-dwelling PWD.