Perioperative mental health intervention for older adults undergoing cardiac surgery

老年人心脏手术围术期心理健康干预

基本信息

批准号：
10206502
负责人：
Michael Simon Avidan
金额：
$ 26.42万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10206502
关键词：
Address Antidepressive Agents Anxiety Attention Behavior Therapy Behavioral Benzodiazepines Cardiac Cardiac Surgery procedures Cessation of life Clinical Research Clinical Trials Design Communication Community Practice Coupled Delirium Depressed mood Effectiveness Effectiveness of Interventions Elderly Emotional Enrollment Event Evidence based intervention Family Fright Goals Grant Healthcare Heart Diseases Hospitals Hybrids Individual Institutes Intensive Care Intervention Mental Depression Mental Health Mental disorders Mission Morbidity - disease rate Motivation Multicenter Trials National Institute of Mental Health Older Population Operative Surgical Procedures Outcome Participant Patient Preferences Patient-Focused Outcomes Patients Perioperative Pharmaceutical Preparations Pharmacology Phase Polypharmacy Population Postoperative Period Preparation Prevalence Prevention Procedures Process Protocols documentation Provider Psyche structure Public Health Quality of life Randomized Randomized Clinical Trials Randomized Controlled Trials Recovery Research Personnel Risk Risk Factors Symptoms Targeted Research Testing Time United States Walking adverse outcome anxiety symptoms anxious base clinical practice clinically significant compare effectiveness depressive symptoms dosage effective therapy effectiveness outcome effectiveness testing experience falls group intervention hospital readmission human old age (65+)implementation outcomes improved innovation interactive feedback medical complication mortality mortality risk multidisciplinary older patient programs protocol development reduce symptoms shared decision making social therapy development time interval treatment as usual trial design

项目摘要

Abstract/Project Summary – PROJECT 3 Depression and anxiety are common but undertreated in older adults undergoing cardiac surgical procedures. Approximately 400,000 older adults undergo cardiac surgery annually in the United States, and between a quarter and a half of these individuals have symptoms of preoperative anxiety or depression. Each of these individuals are at greater risk for depression/anxiety than the general older population. The perioperative period is a particularly vulnerable time, as the patient is concurrently confronted with social, functional and physical changes that accompany a major surgery. Most older adults with heart disease and depression or anxiety do not receive appropriate mental health treatment, and if they do, it is typically limited to pharmacologic interventions, further exacerbating already rampant polypharmacy. In this proposal, we will optimize and test a pharmacological and behavioral intervention bundle for older patients undergoing cardiac surgery, with clinically significant depressive and anxiety symptoms. We will institute a perioperative mental healthcare intervention bundle including: (1) applying a proven behavioral intervention, behavioral activation (BA), with strategies based on patient preferences and needs; and (2) medication optimization and deprescribing (MOD), targeting to optimize dosages of anti-depressant medications, and stopping harmful or ineffective medications. Aim 1 (Adaptation): Informed by a collaborative planning approach, we will adapt, develop and implement an optimal perioperative mental health intervention bundle for older adults undergoing major invasive cardiac procedures. Through stakeholder input, we will develop and iteratively adapt a behavioral and medication optimization intervention bundle for implementation in this population. Following initial protocol development, through treatment development trials, we will iteratively optimize the intervention through interactive feedback from patients over the age of 65 undergoing major cardiac intervention, and other stakeholders, noting barriers and facilitators to program completion. Aim 2 (Testing): Using a hybrid Type 1 randomized controlled trial design, we will compare the effectiveness of the intervention bundle with usual care in reducing symptoms of depression and anxiety in older patients undergoing cardiac surgery. For this aim, 100 patients with symptoms of depression and anxiety will be randomly assigned to the pharmacological and behavioral intervention bundle or usual care. Pre-operative depression and anxiety are associated with a host of adverse outcomes after surgery, including medical complications, falls, delirium, and mortality. Thus, medication optimization and deprescribing, in an intervention bundle with behavioral activation treatment of depression and anxiety in older adults undergoing cardiac surgery, is expected to improve not only symptoms of depression and anxiety but also other important post-operative outcomes.

摘要/项目摘要 – 项目 3 抑郁和焦虑在接受心脏外科手术的老年人中很常见，但治疗不足。在美国，每年约有 400,000 名老年人接受心脏手术，这些人中有四分之一有术前焦虑或抑郁的症状。与一般老年人相比，个人患抑郁/焦虑的风险更大。这段时期是一个特别脆弱的时期，因为患者同时面临社交、功能和大多数患有心脏病和抑郁症的老年人伴随着大手术的身体变化。焦虑症没有接受适当的心理健康治疗，即使接受了，通常也仅限于药物干预，进一步加剧了已经猖獗的多重用药。优化并测试针对接受心脏病治疗的老年患者的药物和行为干预方案手术后，如果有临床上显着的抑郁和焦虑症状，我们将进行围手术期心理检查。医疗保健干预包包括：(1) 应用行之有效的行为干预、行为激活 (BA)，根据患者偏好和需求制定策略；(2) 药物优化和减少处方（MOD），旨在优化抗抑郁药物的剂量，并停止有害或目标 1（适应）：根据协作规划方法，我们将进行适应，为接受手术的老年人制定并实施最佳的围手术期心理健康干预措施通过利益相关者的意见，我们将开发并迭代调整主要的侵入性心脏手术。以下是针对该人群实施的行为和药物优化干预措施。初步方案制定，通过治疗开发试验，我们将迭代优化干预措施通过 65 岁以上接受重大心脏介入治疗的患者的互动反馈，以及其他目标 2（测试）：使用混合类型 1。随机对照试验设计，我们将比较干预组合与常规护理的有效性减少接受心脏手术的老年患者的抑郁和焦虑症状。 100名有抑郁和焦虑症状的患者将被随机分配到药物组和行为干预束或常规护理与宿主相关。手术后的不良后果，包括医疗并发症、跌倒、谵妄和死亡。药物优化和减少处方，在干预措施中结合行为激活治疗接受心脏手术的老年人的抑郁和焦虑预计不仅会改善症状抑郁和焦虑以及其他重要的术后结果。