Health Impacts of Prehospital Pain Management for Injured Older Adults

项目总结 在美国，创伤是老年人死亡和残疾的主要原因。由于生理上的原因 以及老龄化的心理社会过程中，老年人有独特的创伤护理需求。不幸的是，目前的指导方针 创伤护理和紧急医疗服务(EMS)不能充分满足这些需求。院前工作的影响 在治疗受伤的老年人的文献中，对健康结果的关注是一个很大的缺口。 大约10%的受伤老年人在院前间隔时间接受阿片类止痛药治疗疼痛， 或从受伤开始到医院到达的时间。人们对这些干预的后果知之甚少。 院前阿片类止痛药可以通过控制急性疼痛的严重程度来降低精神错乱的风险，从而减少 干扰正常大脑活动和改善健康结果的因素的积累。相反，阿片类疼痛 药物是一种神经活性药物，会扰乱大脑活动，增加精神错乱的风险，并使健康恶化 结果。无论通过哪种途径，院前阿片类止痛的院前给药都对短期和 受伤老年人的长期健康和功能状况。这份申请国家老龄研究所的申请书 导师研究科学家发展奖(K01)寻求对新的外科讲师Molly Jarman博士的支持 在布里格姆妇女医院外科和公共卫生中心，她的职业生涯专注于 改善老年人院前急救和创伤护理系统的质量、有效性和可获得性 美国的人口。Jarman博士之前的研究重点是伤害死亡率的地理决定因素 以及获得创伤中心护理的机会。为了扩大这项研究的影响和实际应用，贾曼博士建议 将她的研究推向老年创伤结果，满足针对以下方面进行优化的创伤护理的新需求 老龄化的美国人口。因此，K01培训的重点是获取老年创伤方面的知识 护理和院前创伤护理服务，以及因果推断和经济分析的统计方法。这个 拟议的研究将使用先进的分析方法来密切检查院前疼痛的影响 管理干预。研究目标将包括(1)评估影响院前EMS使用的因素 阿片类药物对受伤老年人的止痛作用；(2)院前阿片类药物的短期和长期健康结果 止痛，以及(3)估计受伤后第一年的医疗费用。 没有院前疼痛管理。这项工作的实际应用将是为国家、州、 以及寻求在院前休息期间为受伤的老年人提供适当护理的当地EMS领导人， 包括修改业务指南以及在EMS基础设施和/或人员培训方面的投资。通过提供 工资支持，培训，免除行政责任，以及正式的指导结构，这一奖项将 促进Jarman博士过渡到专注于改善健康结果和功能的独立研究生涯 受伤老年人的状况。

PROJECT SUMMARY Traumatic injury is a leading cause of death and disability for older adults in the United States. Due to the physiological and psychosocial processes of aging, older adults have unique trauma care needs. Unfortunately, current guidelines for trauma care and emergency medical services (EMS) to not adequately address these needs. The impact of prehospital care on health outcomes represents a substantial gap in the literature for the treatment of injured older adults. Approximately 10% of injured older adults receive opioid analgesia for pain management during the prehospital interval, or the time from the onset of injury until hospital arrival. Little is known about the consequences of these interventions. Prehospital opioid analgesia could decrease risk of delirium by managing severity of acute pain, and thereby reducing the accumulation of factors disrupting normal brain activity and improving health outcomes. Conversely, opioid pain medications are neuroactive drugs that can disrupt brain activity, increasing risk of delirium and worsening health outcomes. By either pathway, prehospital administration of opioid analgesia has profound implications for short- and long-term health and functional status of injured older adults. This application for a National Institute on Aging Mentored Research Scientist Development Award (K01) seeks support for Dr. Molly Jarman, a new Instructor of Surgery at the Brigham and Women’s Hospital Center for Surgery and Public Health who aspires to a career focused on improving the quality, effectiveness, and accessibility of prehospital EMS and trauma care systems for the older adult population in the United States. Dr. Jarman’s prior research has focused on geographic determinants of injury mortality and access to trauma center care. To extend the impact and practical application of this research, Dr. Jarman proposes to move her research toward geriatric trauma outcomes, addressing the emerging need for trauma care optimized for the aging United States population. Accordingly, the K01 training is focused on gaining knowledge in geriatric trauma care and prehospital trauma care services, as well as statistical methods for causal inference and economic analysis. The proposed research will employ advanced analytic methods to closely examine the impact of prehospital pain management interventions. Research aims will include (1) an assessment of factors influencing EMS use of prehospital opioid analgesia for injured older adults, (2) short- and long-term health outcomes associated with prehospital opioid analgesia, and (3) estimation of Medicare expenditures during the first year following injury for patients with and without prehospital pain management. The practical application of this work will be to inform efforts by national, state, and local EMS leaders seeking to provide appropriate care for injured older adults during the prehospital interval, including changes to practice guidelines and investment in EMS infrastructure and/or personnel training. By providing salary support, training, freedom from administrative responsibilities, and formal mentorship structure, this award will facilitate Dr. Jarman’s transition to an independent research career focused on improve health outcomes and functional status of injured older adults.