Improving Medication Therapy for Older Patients with Common Co-morbidities

描述（由申请人提供）：总体目标是改善患有多种医学疾病的老年人的药物使用。我们的第一步将是从具有代表性的大型老年男性和女性群体的数据库（老年男性的退伍军人管理局数据库和老年和高龄女性和男性的养老院数据库）中确定具有多种共病（“发病类型”）的定义模式的老年人中处方问题的患病率、类型和严重程度。下一步将是开发“潜在优化处方（POP）”算法，预计该算法将导致更少的药物处方，更少的不良反应，并对老年患者适当和有效。开发过程将考虑每种疾病的临床实践指南、用于疾病的药物的药理学特性和相互作用（药代动力学和药效学）以及可能改变疾病治疗方法的老年疾病（功能、预期寿命、弱势老年人护理）。然后，将由来自实践指南、临床药理学和药学、老年病学和卫生保健利用的医学学科的专家对拟议的优化治疗组合进行评估和修改。确定的潜在优化方案将用于设计优化组合和“常规”治疗的后续比较有效性研究。 公共卫生相关性：老龄化通常伴随着越来越多的健康相关诊断和越来越多的药物使用。服用多种药物或“多种药物”使老年患者因药物相关问题而增加药物相互作用和住院治疗的风险。更好地了解目前的药物问题和改进药物治疗方案的发展可以大大有利于绝大多数老年人，或其他人，与多种医疗问题。

DESCRIPTION (provided by applicant): The overall goal is to improve the use of medications for older people with multiple medical disorders. Our first step will be to Identify the prevalence, type and severity of prescribing problems in older people with defined patterns of multiple co-morbidities ("morbidotypes") from databases of representative large groups of older men and women (Veterans Administration databases for older men and Nursing home database (s) for older and very old women and men). The next step will be to develop "potentially optimized prescribing (POP)" algorithms that would be predicted to result in fewer medications prescribed, fewer unwanted effects, and be appropriate and efficacious for the older patient. The development process will consider clinical practice guidelines for each disorder, pharmacologic properties and interactions of medications used for the disorders (pharmacokinetic and pharmacodynamic), and geriatric conditions (function, projected length of life, care for vulnerable elderly) that would modify the approach to treatment of the disorder. The proposed optimized therapeutic combinations will then be evaluated and modified by experts from medical disciplines of the practice guidelines, clinical pharmacology and pharmacy, geriatrics, and health care utilization. The potentially optimized regimens identified will be used to design a subsequent comparative effectiveness study of the optimized combinations and "usual" therapy. PUBLIC HEALTH RELEVANCE: Aging is often accompanied by increasing numbers of health-related diagnoses and increased use of medications. Consumption of multiple medications or "polypharmacy" puts the older patient at increased risk for drug interactions and hospitalizations due to drug-related problems. Better understanding of current medication problems and development of improved medication therapy regimens could greatly benefit the vast majority of older people, or others, with multiple medical problems.